Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure

doi:10.1016/j.ahj.2005.08.016

American Heart Journal

Volume 150, Issue 5, November 2005, Pages 982.e1-982.e9

https://doi.org/10.1016/j.ahj.2005.08.016 Get rights and content

Background

Patients with heart failure (HF) face challenges complying with multidrug regimens.

Objectives

To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF.

Design

Patients were randomized to either usual care or an inhospital educational intervention delivered by a multidisciplinary team (Intervention).

Setting

Acute medical and surgical units at a teaching hospital.

Patients

One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of <40% requiring long-term medical treatment.

Main Outcome Measures

A validated HF-specific instrument provided a measure of knowledge. We characterized patients as noncompliant if pharmacy refill data suggested they had taken ≤0.80 of their medication. We measured quality of life using the Minnesota Living with Heart Failure Questionnaire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality, readmissions, and emergency department visits.

Results

The Intervention group showed higher knowledge scores at discharge and 1 year (P = .05). The risk of noncompliance in Intervention patients varied from 0.78 (95% CI 0.33-1.89) for ACE-I (13% Intervention, 17% Control) to 1.02 (0.49-2.12) for diuretics (23% Intervention, 23% Control). Quality of life improved in both groups over time; the only difference between groups favored the Intervention (Minnesota Living with Heart Failure Questionnaire, P = .04). The composite end point occurred in 67% of control and 60% of Intervention patients (hazard ratio 0.85, 95% CI 0.55-1.30).

Conclusions

An inhospital educational intervention improved knowledge and, possibly, quality of life and may be useful as part of a comprehensive compliance enhancing strategy in patients with HF.

Section snippets

Participants

Patients admitted to the London Health Sciences Centre, Victoria Campus, were eligible if they had HF documented with a low left ventricular ejection fraction (LVEF ≤ 40%), had indications for long-term medical treatment of HF or low LVEF, and provided informed consent as approved by the university-based institutional ethics review board (09091E) (Table I). Patients were excluded if they were <18 years old, were receiving dialysis, had dementia or psychiatric illness, suffered from another

Results

Figure 1 describes the flow of patients through the trial. Our search strategy to facilitate recruitment to the trial was a broad-based approach that essentially targeted any patient with an admission diagnosis of HF, signs or symptoms that may have a differential diagnosis of HF, or a previous discharge diagnosis of HF. Inclusion and exclusion criteria were then applied to the population to derive an eligible study population, yielding 128 patients for evaluation.

Discussion

This multidisciplinary inhospital educational intervention improved knowledge and disease-specific HRQoL acutely, and the effects persisted for 1 year. We were unable to show an effect on compliance, generic HRQoL, or time to event over the 1-year follow-up in this pilot study. It is not surprising that the SF-36 does not have the responsiveness to detect disease-specific changes, as this has consistently been noted in the literature.¹⁶ Although measures of mean compliance suggested high

References (19)

J.F. Steiner et al.
The assessment of refill compliance using pharmacy records, methods, validity and applications
J Clin Epidemiol
(1997)
T.S. Rector et al.
Validity of the Minnesota Living With Heart Failure Questionnaire as a therapeutic response to enalpil or placebo
Am J Cardiol
(1993)
Brogan Report. Utilization of resources for hypertension and heart failure. For Merck Frosst Canada,...
M.B. O'Connell et al.
Evaluation of medication knowledge in elderly patients
Ann Pharmacother
(1992)
M. Monane et al.
Noncompliance with congestive heart failure therapy in the elderly
Arch Intern Med
(1994)
K. Dracup et al.
Management of heart failure. II. Counseling, education, and lifestyle modifications
JAMA
(1994)
F. Gwadry-Sridhar et al.
A systematic review of meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure
Arch Intern Med
(2004)
B.K. Tones
The use and abuse of mass media in health promotion
Health Educ Res: theory and Practice
(1985)
F. Gwadry-Sridhar et al.
Instruments to measure acceptability of information and acquisition of knowledge in patients with heart failure
Eur J Heart Fail
(2003)

There are more references available in the full text version of this article.

Cited by (93)

Actual status of pre-discharge knowledge of hospitalised patients with heart failure and measurement tools to assess said knowledge: A scoping review
2024, Heart and Lung
Heart failure (HF) patients have high readmission rates and require continuous adherence to HF self-care. Lack of knowledge about HF has been identified as a factor that contributes to poor adherence.
To clarify and organise existing data about measurement tools used to assess pre-discharge knowledge of hospitalised HF patients, the content and level of pre-discharge knowledge, factors associated with the level of knowledge, and the effect of knowledge levels on patients’ outcomes.
Four electronic databases were searched for articles that described the content and level of knowledge of pre-discharge HF patients.
Thirty-three studies were included in this review. Twenty-two measurement tools were identified used for pre-discharge knowledge assessment. ‘Heart failure pathophysiology and treatment’ and ‘salt and fluid management’ were the most common knowledge content measured. The level of knowledge of ‘the nature, definition, and causes of symptoms of heart failure’ and ‘fluid and medication management’ tended to be low. High levels of knowledge were found for ‘higher educational background’, ‘previous heart failure hospitalisation’, and ‘previous heart failure education’, while low levels were found for: ‘high number of medications’ and ‘first heart failure hospitalisation’. The level of HF knowledge implies an impact on compliance and self-care.
HF patients have low level of knowledge of the nature and causes of HF and fluid management prior to hospital discharge. Some of the variables that influenced the level of patient knowledge were educational background, number of medications taken, and disease duration.
Assessment of Patient Retention of Inpatient Care Information Post-Hospitalization
2023, Joint Commission Journal on Quality and Patient Safety
Patient understanding of medical care improves readmission rates and patient satisfaction, yet the literature suggests patients often have poor retention of care information post-hospitalization. Although multiple interventions have been implemented to facilitate this process, the cumulative durability of their benefit remains unclear. The authors conducted this study to more objectively understand how well patients retain care information after hospital discharge and to assess patient perspectives on facilitators of this process (for example, whiteboards and patient portals).
Semistructured phone interviews of patients admitted to general medicine resident teaching services were performed within 24 to 48 hours post-hospitalization. Recall of four key domains of care (diagnoses addressed, inpatient treatment, postdischarge treatment plans, and medication changes) was elicited. Chart review was performed to verify patient responses. Responses were then categorized by independent reviewers as correct, partially correct, or incorrect. Patient perspectives on facilitators to help with information retention were also assessed.
Fifty-three patients participated. The vast majority (> 90%) were confident in their knowledge of their diagnoses and treatment, yet independent review revealed only 58.5%, 64.2%, 50.9%, and 43.4% of patients correctly recalled each respective key domain. Whiteboards were the most frequently used facilitator (96.2%), yet their content was rated least helpful for retaining care information. Patients suggested several areas for improvement, including prioritizing bedside pen and paper along with updating whiteboards with diagnostic and therapeutic information.
Patient recall of their inpatient care after discharge, despite modern facilitators, remains poor. Further efforts are needed to enhance or implement facilitators based on patient feedback.
2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures
2020, Journal of the American College of Cardiology
Effectiveness of the Pharmacist-Involved Multidisciplinary Management of Heart Failure to Improve Hospitalizations and Mortality Rates in 4630 Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
2019, Journal of Cardiac Failure
Citation Excerpt :
Among the 9 RCTs, only 4 studies reported a significant improvement and difference in health-related quality of life in HF patients. The quality of life was measured by different instruments: the Chronic Heart Failure Questionnaire,47 EuroQol- 5 Dimension,44,49 the Minnesota Living With Heart Failure (MLHF),45,46,49,50,68,70,72 the 36-Item Short Form Health Survey (SF-36),45,50,68,70 the Dartmouth Primary Care Cooperative Information Project/World Organizations of National Colleges, Academics, Academic Associations of General Practice/Family Physicians,46 and the 15-item Geriatric Depression Scale.70 There are no small studies on the bottom right of the funnel plot of HF hospitalizations so that the typical inverted funnel-like shape was not observed indicating the presence of some degree of publication bias (supplementary Fig. S2a).
There is evidence that heart failure (HF) patients who receive pharmacist care have better clinical outcomes.
English-language peer-reviewed randomized controlled trials comparing the pharmacist-involved multidisciplinary intervention with usual care were included. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and the Cochrane Library from inception through March 2017. Cochrane method for risk of bias was used to assess within and between studies. 18 RCTs (n = 4630) were included for systematic review, and 16 (n = 4447) for meta-analysis. Meta-analysis showed a significant reduction in HF hospitalizations {odds ratio (OR) 0.72 [95% confidence interval (CI) 0.55-0.93], P = .01, I2  =  39%} but no effect on HF mortality. Similarly, a significant reduction in all-cause hospitalizations [OR 0.76, 95% CI (0.60-0.96), P = .02, I2  =  52%] but no effect on all-cause mortality was revealed. The overall trend was an improvement in medication adherence. There were significant improvements in HF knowledge (P<.05), but no significant improvements were found on health care costs and self-care.
The pharmacist is a vital member of a multidisciplinary team in HF management to improve clinical outcomes. There was a great deal of variability about which specific intervention is most effective in improving clinical outcomes.
Knowledge among patients with heart failure: A narrative synthesis of qualitative research
2019, Heart and Lung
Patients’ knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients’ knowledge of HF as part of their lived experience.
We aimed to characterize the nature of patients’ knowledge of HF, in the context of living with the disease.
We conducted a narrative synthesis of qualitative studies that addressed patients’ knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria.
Analysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients’ experience of knowledge.
The nature of patients’ knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.
A systematic review investigating the role and impact of pharmacist interventions in cardiac rehabilitation
2023, International Journal of Clinical Pharmacy

View all citing articles on Scopus

View full text

Clinical InvestigationCongestive Heart FailurePilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure

Background

Objectives

Design

Setting

Patients

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

J Clin Epidemiol

Am J Cardiol

Evaluation of medication knowledge in elderly patients

Ann Pharmacother

Noncompliance with congestive heart failure therapy in the elderly

Arch Intern Med

Management of heart failure. II. Counseling, education, and lifestyle modifications

JAMA

A systematic review of meta-analysis of studies comparing readmission rates and mortality rates in patients with heart failure

Arch Intern Med

The use and abuse of mass media in health promotion

Health Educ Res: theory and Practice

Instruments to measure acceptability of information and acquisition of knowledge in patients with heart failure

Eur J Heart Fail

Clinical Investigation
Congestive Heart Failure
Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure