Published online before print January 10, 2005, doi: 10.1161/01.CIR.0000151811.53450.B8
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(Circulation. 2005;111:179-185.)
© 2005 American Heart Association, Inc.
Heart Failure |
Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure
From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.
Correspondence to Todd M. Koelling, MD, 1500 E Medical Center Dr, Women’s L3623, 0271, Ann Arbor, MI 48109. E-mail tkoellin{at}umich.edu
Received May 28, 2004; revision received August 23, 2004; accepted September 23, 2004.
Background— Although interventions combining patient education and postdischarge management have demonstrated benefits in patients with chronic heart failure, the benefit attributable to patient education alone is not known. We hypothesized that a patient discharge education program would improve clinical outcomes in patients with chronic heart failure.
Methods and Results— We conducted a randomized, controlled trial of 223 systolic heart failure patients and compared the effects of a 1-hour, one-on-one teaching session with a nurse educator to the standard discharge process. Subjects were contacted by telephone at 30, 90, and 180 days to collect information about clinical events, symptoms, and self-care practices. The primary end point of the study was the total number of days hospitalized or dead in the 180-day follow-up period. Subjects randomized to receive the teaching session (n=107) had fewer days hospitalized or dead in the follow-up period (0 and 10 days, median and 75th percentiles) than did controls (n=116, 4 and 19 days; P=0.009). Patients receiving the education intervention had a lower risk of rehospitalization or death (relative risk, 0.65; 95% confidence interval, 0.45 to 0.93; P=0.018). Costs of care, including the cost of the intervention, were lower in patients receiving the education intervention than in control subjects by $2823 per patient (P=0.035).
Conclusions— The addition of a 1-hour, nurse educator–delivered teaching session at the time of hospital discharge resulted in improved clinical outcomes, increased self-care measure adherence, and reduced cost of care in patients with systolic heart failure.
Key Words: heart failure • patients • trials • patient education
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