Ejection fraction moderates the effect of motivational interviewing in improving heart failure self-care: a secondary analysis of the MOTIVATE-HF randomized controlled trial

Aims: To evaluate the effect of a motivational interviewing (MI)-based intervention on self-care maintenance, management, and confidence in patients with heart failure (HF), and to examine whether left ventricular ejection fraction (LVEF) moderates these effects. Methods and results: This was a secondary analysis of a randomized controlled trial comparing an MI intervention with usual care. Outcomes were assessed at baseline and at 3, 6, 9, and 12 months using the Self-Care of Heart Failure Index version 6.2 (SCHFI v.6.2). Generalized estimating equations with exchangeable correlation were used to model repeated measures, adjusting for baseline domain scores. LVEF was included as a continuous moderator, with margins estimated at 30%, 50%, and 70% to aid interpretation. Sensitivity analyses using LVEF categories yielded consistent results. A total of 510 participants were included (42% female; mean age 72.37 ± 12.28 years). MI was associated with significantly higher adjusted scores for self-care maintenance and confidence across follow-up compared with usual care, with larger effects at lower LVEF values. No consistent intervention effect was observed for self-care management. Conclusion: MI was associated with improvements in self-care maintenance and confidence in patients with HF, particularly among those with lower LVEF. These findings support further evaluation of phenotype-informed approaches to MI-based self-care interventions. Registration: ClinicalTrials.gov (NCT02894502).