Abstract 10687: A Focused Heart Failure Self-Care Intervention Reduces Cardiac Deaths in Rural Patients

Abstract

Background: Patients with heart failure (HF) who live in rural areas have less access to interdisciplinary HF programs than patients in urban areas and therefore require high levels of self-care. Objective: To determine the impact of a tailored intervention focused on improving self-care in rural HF patients on cardiac death. Methods: Rural patients (N=602, 40.8% female, 66 ± 13 years, 35.3%) hospitalized for HF within the last 6 months were randomized to one of three groups: usual care or one of two intervention groups (i.e., LITE or PLUS). Both intervention groups included a tailored education and counseling session by a nurse face-to-face that focused on the skills needed to recognize symptoms of escalating HF and appropriate actions. The intervention differed between LITE and PLUS only in the number of reinforcement telephone calls. The LITE group received two, while the PLUS group received bi-weekly calls until the nurse judged them adequately trained (mean 5.3+3.6). Mortality data were analyzed using Cox proportional-hazards regression analysis. Findings: Thirteen percent experienced a cardiac death within the two-years of follow-up. The number of cardiac death-free days survived was significantly different between groups (p=0.016) with LITE patients surviving significantly longer than usual care (p=0.005). The PLUS patients were not significantly different than usual care or LITE patients in cardiac survival. (Figure).

Conclusion: An education and counseling intervention designed to improve self-care in patients with HF who live in rural areas reduces cardiac mortality. Repeated reinforcement sessions may not be necessary to extend survival.