Running Head: DAILY WEIGHTS IN HF PATIENTS 1

Do daily weights done at home by heart failure patients help manage their symptoms and reduce
the frequency of admissions?
Jaclyn Strangie
NURS 611
December 5, 2013
Dr. Fetzer



















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P: Heart failure patients
I: Daily weights done at home
C: Not taking their daily weights at home
O: Frequency of admissions will be reduced and symptoms will be managed

Background and Rationale
In patients with heart failure, daily weights are crucial and should be taken every morning.
Weight gain in HF patients is so important because it means that the heart has to work harder.
The heart has to work harder because the body is retaining fluids. Daily weights are taken when
patients are in the hospital and are important to be taken when theyre discharged as well. Daily
weights are imperative because if there is a sign of weight gain, three pounds in two days or five
pounds in a week, then the patients heart failure may be worsening. In order for HF patients to
properly weigh themselves, they must do it in the morning right after urinating, using the same
scale, and write their weight down. Writing their weight down will help them to recognize a
weight gain more clearly, if there is one.
Daily weights at home in heart failure patients is vital. Patients need to understand how
important its to recognize whether their symptoms are worsening, and the easiest way to do this
is to weigh themselves everyday. Understanding and knowing how their weight is changing will
allow these patients to better manage their heart failure symptoms. Also, daily weights can
contribute to a reduction in the frequency of admissions. Patients need to be educated on the
importance of weighting themselves daily and when to alert their health care providers if they
notice changes.
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Evidence of daily weights is important to practice because it allows nurses to effectively
educate patients regarding this intervention and the effectiveness of it. Patients may think that
theyre gaining weight due to fat. However, the weight theyre gaining is water weight due to
fluid retention. This means that the patients kidneys are not working well and neither is their
heart. This classic sign of HF can be better managed with the proper implementation and
adherence to daily weights. Ultimately, this is an intervention that will improve patient
outcomes. Self-care interventions can improve outcomes, however less than optimal adherence
may limit their effectiveness (Jones et al, 2012).

Search Methods
Using CINAHL, Daily weight in HF patients was searched through the University of New
Hampshires library resource. This search was done through the search engine EBSCO. This
search resulted in 1,748 results. To refine this search, limits were used. The search was limited to
English only, peer-reviewed, conducted within the last ten years, and conducted in the USA.
After applying these limits, the search presented 869 results. After still getting a large amount of
results, the key words excluded were HF patients. The next search included Daily weights in
heart failure. This presented initially with 12,000 results before limiting the search. After
limiting and refining the search, these keywords yielded 953 results.
In order to get a more accurate set of results, the search technique needed to be further
refined. The search was limited to articles that were English only, peer-reviewed, USA,
evidence-based, and full text available. With these limitations, 100 results were found. From the
100 citations identified, this paper will explore three significant resources regarding the
importance and effectiveness of daily weights in heart failure patients.
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Critical Appraisal of the Evidence
White et al, conducted a study on how to improve on the recognition of heart failure
symptoms. These researchers stated the importance of self-care amongst heart failure patients,
with a focus on daily weight monitoring. In this study diaries where daily weights were recorded
by patients at home were evaluated. The purpose of evaluating these journals was to explore the
reasons behind patient non-compliance, prevalence of weight gain within the parameters of HF,
and the frequency of medical-advice seeking behaviors after weight gain had been reported by
patients (White et al, 2010).
In order to conduct this study effectively, these researchers used a cohort study design, which
was part of a pilot study. The pilot study, was used to analyze the response to fluid overload
when recognized by patients. The sample size consisted of twenty heart failure patients that
participated in an educational experience. Following the educational teaching, these patients
were required to record their daily weights in a diary/journal for three months before the
researchers collected the data. Included in the journals aside from the patients daily weights
were their symptoms (if they experienced any) and a record of unplanned hospital visits or phone
calls to their health care providers (White et al, 2010).
After collecting and analyzing all of the data from these journals, the sample size was reduced
to sixteen participants. It was interesting to note that in the findings of the study, 75% of these
patients had significant weight gains of three or more pounds in one day. From these weight
gains, only one patient had made it a point to contact their health care provider (White et al,
2010). It was concluded that if more patients had contacted their health care provider, there
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would have been a more significant reduction in hospital visits among these heart failure
patients.
Although this study provided a one-on-one education section that focused on fluid
management and daily weights, these patients were unaware of the effectiveness of contacting
their health care provider. This was proven when only one out of the sixteen patients reached out
for help. The goal of this study was to introduce the significance of self-weighing daily in order
to recognize the need for help. The researchers concluded that after only one out of sixteen
participants contacted their health care provider, that more education revolving this intervention
must be taught. It was hypothesized that if more participants contacted their health care provider
with the significance of their weight gain, that there HF symptoms would be managed
appropriately.
This study excelled in stressing the importance of keeping a diary in order to recognize
symptoms and the effectiveness of adhering to this intervention. However, the importance of
contacting a health care provider when these symptoms arose was one of the main reasons for
keeping the diary. Based off the results, this didnt seem to be clear to the participants, and
could have been further taught; therefore this was a limitation to this study.
Chaudhry et al, conducted the second study. This study explored the patterns related to
weight change, preceding hospitalization in HF patients. This study analyzed data over an 18-
month period. Patients with heart failure used the Alere home monitoring system (Chaudhry et
al, 2007). This system provided patients at home with an electronic scale that was linked via a
standard phone line to a computerized database that was monitored by trained cardiac nurses
(Chaudhry et al, 2007). This was a unique way of being able to directly monitor patients daily
weights and observe for changes.
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This study calculated daily weights and changes by subtracting baseline weight, which was
the first weight entered into the Alere system, from the patients weight on a given day. The
method used in this study was considered a case-control study. Case patients who were
hospitalized for HF were matched with control patients who didnt have a HF hospitalization.
There were 134 participants in both the case and control categories of this study. Of these
patients, the majority of them were in the Class III category of heart failure and were monitored
for about 291 days (Chaudhry et al, 2007). Class III HF was the severity of HF these patients
were placed into, it was considered to be moderate according to the NY Heart Association
classification of HF. This meant that patients had a marked limitation of physical activity and
were comfortable at rest, but had less than ordinary activity results in fatigue, palpitation, or
dyspnea.
The most significant finding of this study was that the increase in body weights began to start
at least one week before patients were hospitalized. This was indicative of an increase in weight
over a short period of time before hospitalization, leading to the management of symptoms for
those participants who chose to seek help. It was noted that there were some patients who had a
weight gain for about 30 days prior to contacting their health care provider. This contributed to a
more serious case than those who recognized and acted on their weight gain initially.
This study accurately explored this intervention. The researchers explored data and results
from actual patients participating in a home monitoring system, rather than a clinical trial with
strict inclusion-exclusion criteria and complex follow-up procedures (Chaudhry et al, 2007).
Therefore, this study was able to find a more accurate way to determine the effectiveness of daily
weights and the need to seek help in order to properly manage symptoms. One limitation noted
in this study was that it only included data from NYHA Class III HF patients. This study stated
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that patients with Class I or II HF did not meet the criteria and severity of HF that was required
in order to purchase an electronic monitoring system for their home (Chaudhry et al, 2007). This
limited the study to only one class of HF rather than patients with heart failure as a whole, no
matter the severity of their disease.
Jones et al conducted the final study. This study explored whether or not adherence to weight
monitoring or weight-based diuretics were associated with fewer heart failure related
hospitalizations. A nested case-control analysis was performed in a heart failure self-care
randomized control trial. Participants in this study were diagnosed with either systolic heart
failure or had a preserved ejection fraction that placed them in the New York Heart Associated
class of II-IV (Jones et al, 2012). Participants were having symptoms of HF within six months
prior to this study and were also on a loop diuretic.
There were two hundred and ninety-seven participants that each participated in self-care
trainings regarding daily weights and diuretic self-adjustments. Following the training, these
participants had to record their weight and whether or not they adjusted their diuretic in a daily
journal. Along with keeping a daily journal, participants received several follow-up phone calls
that reinforced weight monitoring, proper diuretic use, adherence, salt avoidance, and exercise
(Jones et al, 2012). Participants were provided with their own digital scale for their bathroom, as
well as a special journal to complete daily. The subjects were either placed in a case time period
or a control time period. The control time period category meant that there was no heat failure
event noted i.e. no hospitalization. A case time period consisted of a heart failure related
hospitalization seven days preceding this study. The time period of seven days was chosen based
off clinical findings showing that significant weight changed usually occurred seven days
preceding heart failure related hospitalizations (Jones et al, 2012).
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After analyzing each diary, individuals were placed in a category of adherence of nonadherent.
If participants did not record or return their journaling data, they were placed in the nonadherent
category. This study found that among all the participants, eighty-one heart failure related
hospital visits in fifty-four patients over one year of follow-up (Jones et al, 2012). The main
finding of this study was that adhering to daily weight monitoring and diuretic self-adjustment
were both associated with lowering the odds of having a heart failure related hospitalization.
This study essentially proved that adhering to self-care activities at home i.e. daily weights could
help reduce heart failure symptoms and may contribute to improving patient outcomes.
This study had a significant amount of strengths and did a great job in exploring adherence to
self-care interventions, such as daily weight monitoring and self-adjustment of diuretics. In this
study, they performed several sensitivity analyses to check for bias. A limitation of this study
was found when the method in which they chose to measure adherence (journal) could have been
a source of bias. Also, the researchers considered nonreported data to be nonadherent, which
certainly could have affected their results (Jones et al, 2012). Just because they didnt receive
the data, doesnt mean the participants werent recording their weights and diuretic doses
properly.

Evidence Synthesis
After analyzing and exploring the evidence appraised, its indicative that daily weights are a
crucial intervention for patients with heart failure. As proven and discussed in these studies,
patients who take their daily weights at home and record them effectively have less frequent
admissions than those HF patients who do not adhere to this intervention. The evidence found
can be used to better educate patients with HF on the importance of taking their weights daily.
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Fluid overload is one of the main and most significant symptoms associated with HF and patient
admissions. Its up to the patients at home to recognize how to interpret their weight gain and be
able to understand when to call for help.
If HF patients recognize a significant and sudden weight gain and are able to catch it in time,
this patient will have a better outcome than a HF patient who does not adhere to taking their
daily weights. Daily weights go along with many other interventions necessary for HF patients,
but certainly are crucial in the management of symptoms. With optimizing self-care adherence,
such as daily weight monitoring, improved outcomes for patients with heart failure could be
possible (Jones et al, 2012).

Clinical Research Recommendation
In future research it would be effective to explore and determine the effectiveness of
discharge teaching done by the health care team in regards to the importance of daily weights in
heart failure patients. Its important that nurses and other members of the interdisciplinary team
understand the purpose of this intervention and are able to accurately educate patients on this
matter. In order for HF patients to better understand how to manage their symptoms and adhere
to taking their daily weights, nurses must be able to explain thoroughly proper discharge
instructions related to self-weight monitoring in order to improve patient outcomes. Its
imperative that nurses improve their discharge planning and that patients are able to carry out
these self-monitoring activities necessary to prevent further complications.
Although daily weights are not the only intervention for heart failure patients, it has been
shown that they can contribute to improving patient outcomes and management of their
symptoms. In doing this, there is a good chance that self-monitoring would reduce further
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hospitalizations. Its important to stress routine daily weights and the recognition of adverse
symptoms, such as sudden weight gain and what a sudden weight can indicates. Further research
will continue to be done regarding this intervention and why it is required at home, due to the
fact that research regarding daily weight monitoring is still unclear.



















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References

Chaudhry, S., Wang, Y., Concato, J., Gill, T., & Krumholz, H. (2007). Patterns of weight
change preceding hospitalization for heart failure. Circulation, 116(14), 1549-
1554.
Jones, C., Holmes, G., Dewalt, D., Erman, B., Broucksou, K., Hawk, V., &
Pignone, M. (2012). Is adherence to weight monitoring or weight-based diuretic self-
adjustment associated with fewer heart failure-related emergency department visits or
hospitalizations?. Journal Of Cardiac Failure, 18(7), 576-584.
doi:10.1016/j.cardfail.2012.05.004
White, M., Howie-Esquivel, J., & Caldwell, M. (2010). Improving heart failure
symptom recognition: a diary analysis. Journal Of Cardiovascular Nursing,
25(1), 7-12. doi:10.1097/JCN.0b013e3181b7af9e











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