Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure

Koelling, T.M.; Johnson, M.L.; Cody, R. J.; Aaronson, K.D.

doi:10.1016/j.accreview.2005.04.003

Cited by 73 publications

(137 citation statements)

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“…34 Several studies have shown that multidisciplinary interventions instituted after discharge from a hospitalization for an episode of heart failure have been shown to improve clinical outcomes. [35][36][37] In light of the high postdis-charge event rates observed in our study, the importance of patient education and regular evaluation in the postdischarge period should be stressed. Regardless of QRS duration, the event rate was high despite standard medical therapy and the exclusion of major comorbid conditions.…”

Section: Commentmentioning

confidence: 90%

Clinical Implications of QRS Duration in Patients Hospitalized With Worsening Heart Failure and Reduced Left Ventricular Ejection Fraction

Wang

Maggioni

Konstam

et al. 2008

JAMA

179

124

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Context Hospitalization for heart failure is associated with high postdischarge mortality and morbidity. The predictive value of the QRS duration during admission for heart failure has not been well studied. Objective To investigate the predictive value of the QRS duration in patients hospitalized for heart failure with reduced left ventricular ejection fraction (LVEF). Design, Setting, and Participants Retrospective, post hoc analysis from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST), an event-driven, randomized, double-blind, placebo-controlled study in patients hospitalized for heart failure and having an LVEF of 40% or less. A total of 4133 patients were enrolled at 359 North American, South American, and European sites between October 7, 2003, and February 3, 2006. After excluding 1029 patients with a pacemaker, implantable cardioverter-defibrillator, or both at enrollment and 142 patients without a reported baseline QRS duration, 2962 patients were included in the analysis: 1641 had a normal QRS duration (Ͻ120 ms) and 1321 had a prolonged QRS duration (Ն120 ms). Main Outcome Measures Dual primary end points were all-cause mortality and the composite of cardiovascular death or hospitalization for heart failure. Results During a median follow-up of 9.9 months, all-cause mortality was 18.7% for patients with a normal baseline QRS duration and 28.1% for patients with a prolonged baseline QRS duration (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.38-1.87). The composite of cardiovascular death or hospitalization for heart failure was 32.4% for patients with a baseline QRS duration less than 120 ms and 41.6% for patients with a baseline QRS duration of 120 ms or greater (HR, 1.40; 95% CI, 1.24-1.58). The increased risk associated with prolonged QRS duration was confirmed after adjusting for multiple variables for all-cause mortality (HR, 1.24; 95% CI, 1.02-1.50) and the composite of cardiovascular death or hospitalization for heart failure (HR, 1.28; 95% CI, 1.10-1.49). Only 105 patients (3.6%) who presented with a prolonged baseline QRS duration had a normal QRS duration on their last inpatient electrocardiogram. Conclusion A prolonged QRS duration appears common in patients with reduced LVEF who are hospitalized for heart failure and is an independent predictor of high postdischarge morbidity and mortality.

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Section: Commentmentioning

confidence: 90%

Clinical Implications of QRS Duration in Patients Hospitalized With Worsening Heart Failure and Reduced Left Ventricular Ejection Fraction

Wang

Maggioni

Konstam

et al. 2008

JAMA

179

124

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“…Heart failure management is a public health priority. The multidisciplinary approach to managing it has been shown to improve outcome, in particular in terms of hospitalisation [4][5][6]8]. However, the role of the community pharmacist has not been evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…The first questionnaire, for pharmacists, was subdivided into five parts: 1/pharmacist characteristics: permanent (yes or no), how long he has had his qualifications (< 5, (5-9), (10)(11)(12)(13)(14), > 15 years), pharmacy location (country, city center, urban district, shopping center), number of follow-up heart failure patients (0, (1-5), (6)(7)(8)(9)(10), (11)(12)(13)(14)(15), > 15), faithful patients (yes or no); 2/ knowledge of heart failure (disease, alert signs of decompensation, drug therapy, contraindicated drugs, hygieno-dietetic management, medical supervision, essential vaccinations, patient association) and role to play (in dispensing drugs, educating patients about their disease and treatment, informing patients about over-the-counter drugs and the importance of observance, referring patients to other health professionals or patient/support associations, providing medical equipment, giving advice by phone, distributing brochures about heart failure); 3/asked questions by patient: frequently (yes or no), ability to answer (frequently, sometimes, rarely, never), adopted behaviour if no answer (searching for answer in documents, on internet, contacting the patient's physician); 4/initial university training (very satisfactory, satisfactory, insufficient, very insufficient) and continuing education (necessary, yes or no); 5/therapeutic education: knowledge (yes or no), investment and motivation to provide it (yes or no), privacy space (yes or no).…”

Section: Methodsmentioning

confidence: 99%

“…Although many causes of heart failure exacerbations requiring hospitalisation can be identified, medication and dietary noncompliance have been reported as contributing factors in up to 33% of hospitalised patients [3]. However major advances in both diagnosis and management have occurred and will continue to improve symptoms and patient outcomes [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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How the community pharmacist contributes to the multidisciplinary management of heart failure

Chauvelot¹,

Nerich²,

Limat³

et al. 2010

Health

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Objective: To define how the community pharmacist contributes to the management of heart failure by exploring the type of service he provides to patients and by assessing what patients expect from him. Setting: Pharmacists of the Franche-Comte region (France) and patients of the Franche-Comté Heart Association. Method: Two questionnaires were drawn up and sent to pharmacists and patients. Results: The 118 pharmacists participating in this survey (36.9%) felt that they had a role to play in dispensing drugs (100.0%), educating patients about their treatment (83.1%), informing patients about the importance of observance (81.4%) and over- the-counter drugs (58.5%), distributing heart failure brochures (51.7%) and providing medical equipment (44.9%). On the other hand, only a third of them thought that they should inform patients about their illness and give advice by phone. On the whole, knowledge level is good for disease, drug therapy, contraindicated drugs, medical supervision and hygieno-dietetic management, but intermediate or poor for alert signs of decompensation, essential vaccinations and patient associations. University training in this area during formal pharmacy studies is considered either “insufficient” or “very insufficient” in 56.9% of cases. Although more than 99% of the pharmacists think that additional training is needed, only 33.1% had actually benefited from such training. Of the 96 patients (48.0%) who completed the questionnaire, 92.6% are faithful to their pharmacist. They contact him more about drug therapy than about their disease, or information related to treatments. Roles attributed to their pharmacist are mainly related to drug therapy explanation and information concerning over-the-counter drugs. Therapeutic education is known to 40.6% of interrogated patients. Among these patients, two-thirds depend on their pharmacist and feel that he is capable of providing the necessary education. Moreover, 46.2% of patients had received some form of therapeutic education from their pharmacist. Pharmacists believe that they are able to assume this role in 67.8% of cases. Conclusion: In spite of biases, this study allowed us to assess the expectations of heart failure patients with regard to the pharmaceutical management of their disease, thus clarifying the indispensable contribution that pharmacists make in the management of this disease

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“…As a result, self-care interventions need to be standardized and feasible for clinicians across health care settings. 55,56 Consideration of patient factors such as adequacy of social support, health literacy, cognition, depression, socioeconomic status, and advanced age is also important when choosing an intervention. 11,21 Importantly, patients with HF seek information on how to negotiate all the components of self-management in addition to understanding medications, dietary restrictions, and symptom monitoring.…”

Section: Research Implicationsmentioning

confidence: 99%

Heart failure self-care interventions to reduce clinical events and symptom burden

McGreal¹,

Hogan²,

Walsh-Irwin³

et al. 2014

RRCC

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Background: Lack of adherence to prescribed therapies and poor symptom recognition are common reasons for recurring hospitalizations among heart failure (HF) patients. The purpose of this literature review is to examine the effectiveness of HF self-care interventions in relation to clinical events and symptom burden. Methods: A systematic review of randomized controlled trials with a HF self-care measure was conducted. The PubMed, CINAHL, and Medline databases were searched between 2010 and 2014, using the keyword "heart failure" in combination with the terms "self-care", "self-management", "self-care maintenance", "self-care confidence", "symptoms", and "hospitalizations". Outcomes of interest were clinical events and/or symptom burden. Results: Nine studies met the inclusion criteria. HF education was the core of all interventions examined. Dose and strategies varied across studies. All interventions that effectively decreased clinical events included education on how to respond to worsening HF symptoms. Conclusion: Knowledge alone does not improve HF self-care behaviors or reduce the risk of clinical events and/or symptom burden. Interventions that augment self-confidence or selfefficacy to perform optimal self-care management and self-care maintenance may be useful.

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Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure

Cited by 73 publications

References 0 publications

Clinical Implications of QRS Duration in Patients Hospitalized With Worsening Heart Failure and Reduced Left Ventricular Ejection Fraction

Clinical Implications of QRS Duration in Patients Hospitalized With Worsening Heart Failure and Reduced Left Ventricular Ejection Fraction

How the community pharmacist contributes to the multidisciplinary management of heart failure

Heart failure self-care interventions to reduce clinical events and symptom burden

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