diary, heart failure, outcomes, self-monitoring, somatic awareness



  1. Eastwood, Cathy A. BN, MN
  2. Travis, Lucille PhD, RN, CNA, BC
  3. Morgenstern, Tanya T. MSN, MPH
  4. Donaho, Erin K. RN, BSN


Background: For people with chronic heart failure, self-monitoring has been linked with improved body awareness and better communication with health professionals. Cognitive theory and the concept of somatic awareness help explain self-monitoring behaviors. This study compares the clinical and hospital outcomes of heart failure patients who are using and not using a diary to record weight, vital signs and, symptoms and evaluates the diary format.


Methods: All patients enrolling in an outpatient heart failure clinic were given a Heart Health Diary. Seventy patients used the diary and 54 did not. A review of these 124 patients (82 men and 42 women) was completed 6 months after enrollment.


Results: Diary nonusers were more likely to be younger women with a lower ejection fraction and worse functional status. Those using a diary had 35% and 47% more contacts via telephone and clinic, respectively. Both groups had significant functional and B-type natriuretic peptide improvement. If hospitalized after enrollment in the heart failure clinic, average length of stay for all hospital admissions for diary users decreased by 58% (P < .002) and average cost per case decreased by 56% (P < .011). Length of stay and cost per case did not significantly change for those not using diaries.


Conclusion: Diary users showed evidence of improved clinical and hospital outcomes. Further investigation is needed to clarify the characteristics of a diary user and the effect of diary use on self-management and outcomes.