Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial.

Monica Isabelle Lopes Oscalices,Cassia Regina Vancini Campanharo,Meiry Fernanda Pinto Okuno,Ruth Ester Assayag Batista,Maria Carolina Barbosa Teixeira Lopes

doi:10.1590/1518-8345.2484.3159

Monica Isabelle Lopes Oscalices, Cassia Regina Vancini Campanharo + Show 3 more

Open Access

https://doi.org/10.1590/1518-8345.2484.3159

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Abstract

Objective to evaluate the effectiveness of the behavioral intervention of discharge guidance and telephone follow-up in the therapeutic adherence, re-hospitalization and mortality of patients with heart failure.Method randomized clinical trial without blinding, including 201 patients diagnosed with heart failure admitted to the emergency room, who were randomized in Control Group and Intervention Group. Intervention was carried out with specific discharge guidance in the Intervention Group, who were contacted for solving doubts via phone calls after 7 and 30 days, and the adherence to treatment was evaluated after 90 days with the Morisky test, the Brief Medical Questionnaire and the non-drug adherence test in both groups. The Generalized Estimating Equations Model was used (p<0.05%).Results One-hundred and one patients were randomly sorted in the Control Group and in the Intervention Group, their average age being 62.6±15.2. The Intervention Group had higher drug and non-drug therapeutic adherence compared to the Control Group (p<0.001) and there were lower re-hospitalization and death rates in the Intervention Group after 90 days.Conclusion discharge guidance with telephone follow-up was effective and resulted in greater therapeutic adherence, as well as in decrease of re-hospitalization and death rates in patients with heart failure. Clinical Trial Registration (REBEC): RBR- 37n859

Highlights

Heart Failure (HF) represents a problem with great magnitude, as it is the second most common cause of death due to cardiovascular diseases in Brazil
The high number of hospital admissions due to HF, nearly one million annual hospitalizations, is commonly associated with decompensation of the disease, which can be triggered by cardiovascular factors, like ischemia and arrhythmias, and non-cardiovascular factors, like various types of infection
This study aimed to evaluate the effectiveness of the behavioral intervention of discharge guidance and telephone follow-up in the therapeutic adherence, re-hospitalization and mortality rates of patients with heart failure

Summary

Introduction

Heart Failure (HF) represents a problem with great magnitude, as it is the second most common cause of death due to cardiovascular diseases in Brazil. The high number of hospital admissions due to HF, nearly one million annual hospitalizations, is commonly associated with decompensation of the disease, which can be triggered by cardiovascular factors, like ischemia and arrhythmias, and non-cardiovascular factors, like various types of infection. Another important factor in the clinical decompensation of these patients is the non-adherence to the treatment recommended for the disease[4-5]. Discharge guidance is an important factor in the improvement of the patient’s understanding of the disease and of adherence to treatment. For an effective discharge guidance, it is important that it is conducted individually and according to the patients’ understanding of their disease[7-8]

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