Impact of a Comprehensive Heart Failure Self Care Review

Abstract

Introduction Heart failure (HF) is one of the common reasons for hospital admissions in patients 65 years and older. 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 self-care education in a HF clinic. Methods Since July 2015, 57 patients new to Advanced Integrated Medical and Surgical (AIMS) HF program were enrolled. After informed consent and baseline data collection including the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Morisky Medication Adherence Score (MMAS-4), New York Heart Association (NYHA) functional classification, and medication knowledge score, patients underwent self-care education 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 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 analysis was completed in 50 patients. Of these, 100% were Caucasian and 74% (37) were male, with a mean age of 66.7 ± 10.6 years. Mean baseline ejection fraction (EF) was 29.2% ± 13.3% and ranged from 15-60%. Most patients (74%, n = 37) were NYHA class III at baseline. NYHA functional class significantly improved from baseline: I-2 (4%), II-10 (20%), III-37 (74%), IV-1 (2%) to 12 months post-intervention: I-11 (23%), II-10 (21%), III-25 (53%), IV-1 (2%), p = 0.003. The following KCCQ parameters also significantly improved: symptom burden score pre-72.8 ± 25.1 vs post-82.4 ± 22.9, p = 0.02, total symptom score pre-73.0 ± 23.2 vs post-81.1 ± 21.4, p = 0.03, self-efficacy pre-80.9 ± 20.1 vs post-92.9 ± 10.9, p Conclusion A customized self-care HF review using a standardized tool was associated with significant improvements in NYHA class and improvements in patients’ perceptions of symptom burden, self-efficacy, QOL, social limitation, and overall KCCQ summary scores at 12-months post intervention. Medication adherence and knowledge also improved. Larger, longitudinal studies are further warranted to assess the durability of results and to determine if these improvements translate into other improved clinical outcomes.