Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure

Abstract

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 (nϭ107) had fewer days hospitalized or dead in the follow-up period (0 and 10 days, median and 75th percentiles) than did controls (nϭ116, 4 and 19 days; Pϭ0.009).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; Pϭ0.018). 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 (Pϭ0.035). 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.

Rehospitalization for Heart Failure

“…Comprehensive discharge planning, including patient and caregiver education, guidance regarding sodium and fluid restriction, collaboration with visiting nurses, and planned follow-up, may reduce early readmission rates by as much as 25%. 41,42 Particularly important may be the follow-up within 7 to 10 days, which has been widely implemented after recognition that nearly half of heart failure readmissions occurred before the first ambulatory visit. 43 Outcomes appear to be best when follow-up involves collaborative care between a cardiovascular specialist and the primary care physician.…”

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies

“…These conclusions were further supported by randomized trials demonstrating that predischarge education results in improved adherence to therapy, better quality of life and modest reductions in resource use (27,28). Successful transition programs are usually coordinated by an RN/ANP (29)(30)(31).…”

Fluid Management Strategies in Heart Failure

“…Education before hospital discharge [41][42][43] ; counseling [43][44][45][46] ; and follow-up programs after discharge, 47,48 including transition-tohome, 43,46 telephone, and other forms of remote monitoring 48,49 programs, were associated with adherence to prescribed therapies and fewer rehospitalizations after discharge. However, most strategies used to minimize preventable hypervolemia and subsequent morbidity and mortality were not well described and therefore are hard to replicate.…”