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

Abstract

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 < or = 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.