292 - Impact of a Comprehensive Heart Failure Self-Care Review 12-Month Assessment

Abstract

Purpose: Heart failure (HF) is one of the most common reasons for hospital admissions in patients ≥65 years. Despite recent advances, patients are still frequently hospitalized with efforts to reduce readmissions. The 2013 ACCF/AHA guidelines list HF education, including self-care, as a class I recommendation. The purpose of this study is to assess a self-care education program in a HF clinic. Methods: Since July 2015, 49 patients new to the Advanced Integrated Medical and Surgical (AIMS) program for HF were enrolled in the study. After informed consent and baseline data collection including the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Morisky Medication Adherence Score (MMAS-4), and medication knowledge score, patients underwent self-care education with the Principal Investigator (PI) using a standardized self-care education tool developed by the PI. The education was customized based on health literacy as assessed by the Rapid Assessment of Adult Literacy in Medicine (REALM) score. Patients were contacted at 6 and 12-months for re-assessment of clinical outcomes. Changes in numerical values were compared pre- and post-intervention using paired student's t tests and changes in categorical variables were compared using Wilcoxon Signed Ranks test. Results: Twelve-month interim analysis was completed in 25 patients. Of these, 100% were Caucasian and 64% (16) were male, with a mean age of 70.6 ± 8.1 years. Mean baseline ejection fraction (EF) was 34.5%±12.5% and ranged from 15–60%. Most patients (80%, n = 20) were New York Heart Association (NYHA) class III at baseline. The following KCCQ parameters significantly improved at 12-months: symptom burden score pre-65.0 ± 25.7 vs post-77.1 ± 26.1, P = .03, total symptom score pre-66.2 ± 24.8 vs post-76.5 ± 22.6, P = .046, self-efficacy pre-78.1 ± 19.2 vs post-90.4 ± 12.3, P = .002; quality of life (QOL) pre-56.4 ± 24.5 vs post-70.3 ± 19.9, P = .003; social limitation pre-59.2 ± 34.1 vs post-80.8 ± 20.2, P < .001; overall summary score pre-62.5 ± 24.1 vs post-76.1 ± 20.0, P < .001; and clinical summary score pre-67.3 ± 23.6 vs post-76.8 ± 22.6, P = .03. Patients also experienced improvements in their MMAS-4 score; pre-0.48 ± 0.6 vs post 0.05 ± 0.2, P = .002. Percentage score on knowledge assessment also increased from 75 + 2 to 95 + 8, P < .001. Conclusion: A customized self-care HF review using a standardized tool was effective in improving patients' perceptions of symptom burden, self-efficacy, QOL, social limitation, overall and clinical KCCQ summary scores at 12-months post intervention. Medication adherence and knowledge also improved. Larger, longitudinal studies are further warranted to determine if these improvements translate into improved clinical outcomes.