Abstract 1819: Nurse-led Intervention Can Improve Adherence To Non-pharmacological Treatment In Heart Failure Patients; Data From The Coach Study
Introduction Adherence to medication in heart failure (HF) patients is well studied, however, little is known on adherence to non-pharmacological treatment or the effect of interventions to improve adherence.
Aim The aim of this study was to examine the effect of education and counseling by a HF nurse on adherence to sodium restriction, fluid restriction and daily weighing in HF patients in a well powered study.
Method A sample of 1023 hospitalized HF patients (mean age 71±11; 38% female; LVEF 34±14) from 17 Dutch hospitals were included and randomized into 3 groups;
care as usual with regular visits to the cardiologist;
basic education and counseling by a HF nurse with regular visits to the HF clinic;
intensive education and counseling by a HF nurse and a multidisciplinary team with at least monthly contact.
Patients were followed for 18 months. Basic characteristics were assessed and patients completed validated questionnaires on adherence and HF knowledge at baseline and 1, 6, 12 and 18 months. Differences in adherence between the 3 groups were assessed using Chi2-test.
Results Patients in the intervention groups were significantly more adherent to the regimen at all follow-up moments. Adherence to fluid restriction improved from 67% at baseline to 90% (p<.01), adherence to diet from 75 to 90%. Most important differences were seen in daily weighing; 56% in the control group weighed at least 3 times a week, versus 89% in the intensive intervention group (P<.01). There were also significant differences in adherence with daily weighing between basic and intensive support (79% vs. 89%; p<.01). Significantly more intervention patients knew they had to call a doctor or HF nurse in case of sudden weight gain (86% vs. 69%, p<.01). Patients in all groups improved their adherence to lifestyle changes during the first month after discharge, however only patients in both intervention groups became and stayed significantly more adherent during follow up.
Conclusion In this cohort of elderly HF patients, HF knowledge and adherence to the non-pharmacological regimen improved significantly after education by a HF nurse. A basic form of support seems to increase patient adherence significantly, intensive support only further increased adherence to daily weighing.