Therapeutic education and chronic heart failure

Abstract

Heart failure (HF) is one of the most common causes of hospitalization and readmission in cardiology with increased morbidity and mortality in symptomatic cases. Patient self management is crucial, but quite complex: follow numerous medical regimens, comply with diet and exercise recommendations, actively engage with clinicians, modify medications and behavior according to clinical changes. The consequences of inadequate self care are deleterious as inability to manage medications or diet may account for as many as 1/5 admissions for HF (Chin Goldman, 1997) Conversely, improved self-management skills may reduce the odds of readmission at 1 year by 40% (Jovicic Holroyd-Leduc, 2006). Thus, assisting patients to manage their own care is an essential component of chronic HF management. In a pragmatic approach, it is clear that therapeutic education (TE) contains have to be individualized according to the educative diagnosis in order to identify self care limitations. The reasons for inadequate self care reflected by low adherence rates are multifactorial: lack of knowledge, skills or commitment, but also socioeconomic, personal, and treatment factors. Clinicians must be aware of these impediments to self care in order to maximize their patients’ ability to manage their disease. Furthermore, knowledge and skills are ineffective without engagement. Clinicians and educators’ problematic is to find how to increase patient involvement and engagement with some motivational interviewing techniques. Therefore, phychiatrist and cardiologist physicians may coordinate specific programs including: - TE in transdisciplinary programs: group and individual cardiac rehabilitation is supported by training and performance improvement after acute event, with specific behavioral and cognitive approach; - transversal care as patients with heart failure are older adults with mobility, balance, eyesight, hearing, executive functions impairments; - longitudinal perspective as interdisciplinary approach must provide appropriate adaptation and coordination of care, ensure adequate patient education to support the acquisition of self care skills, and create safe transitions of care between settings for short and long-term adherence.