CHF Patient education to self-management reduces all causes mortality in a long-term perspective

Abstract

Chronic heart failure patients education to self-management is recommended by international guidelines but is still underuse by clinicians. Actually only 5–10% of CHF patients benefit from multidisciplinary education in Europe. Many studies have underline the short- or mild-term impact of education on hospitalization but only few on mortality. The aim of our study was to analyse the long-term impact (8 years) of a structured multidisciplinary education of CHF patients and relatives using simple tools (paperboard, games, quiz) on all causes mortality. Methods We have prospectively included 803 consecutive CHF patients referred to our heart failure center since 2001. Patient education was proposed to all patients and was done only in 264. Education was done on Monday and Tuesday. Some refused and some were referred out of the education days. Education was based on an educational diagnostic done by a nurse, a discussion between doctor and a group of 6 patients and relatives and a discussion between physiotherapist and patients. At the end of the session, patients use a game tool analyzing reactivity and knowledge. We have followed the patients in the same way with the same clinicians in charge of optimizing HF therapy. Mean follow up was 8 ± 4 years. The main end point was all cause mortality. Results The two groups (Education vs no education) were comparable in term of age, LVEF (33 ± 11 vs 38 ± 13%) left ventricular filling (E/A 0,9 ± 0,2 vs 1,31 ± 1) renal function (creatininemia 114 ± 94 vs 116 ± 113 μmol/l) and BNP (313 ± 463 vs 533 ± 770 pg/mL)) and comparable in term of CH F therapies. During follow up, annual mortality rate was 3,19% in therapeutic education group versus 4,8% in the no education group ( p : 0,0369). Conclusion Education of CHF patients is a long-term effective tool in order to reduce long-term mortality. Our HF tool kit using face to face discussions and reactivity based games is not really time consuming (3 hours nurse/1 hour physiotherapist for a group from 6 to 8 patients) and is effective in order to reduce long term all cause mortality by 1/3. Due to its impact in real life, patient education to self-management should be promoted in CHF patient management and done in every HF center.