[An educative intervention to improve treatment compliance and to prevent readmissions of elderly patients with heart failure]

Abstract

Background and objective: To assess the efficacy of a multifactorial intervention at discharge in elderly patients with heart failure to improve the adherence to treatment, reduce readmissions and days of hospitalisation, and to evaluate its effect on quality of life.

Patients and method: A prospective, randomized clinical trial. Subgroup analysis in elderly patients (older than 70 years) admitted for heart failure. Patients were randomized into 2 groups: intervention and control. The intervention consisted of comprehensive education about the disease, drug therapy, diet, and telephonic strengthening. Rates of readmission, treatment compliance, and quality of life were evaluated at 6 and 12 months postdischarge.

Results: 103 patients were included (53 intervention and 50 control), with a mean age of 79 years and ventricular function predominantly preserved. Both study groups were comparable with regard to baseline sociodemographic and clinical variables. At 6 months, patients in intervention group had a more compliance degree (91.2% vs 68.0%; p = 0.04), were less readmitted (22.6% vs 42.0%; p = 0.03), and number or readmissions/patient (0.3 vs 0.8; p = 0.02) and total days of hospital stay were significantly lower (2.6 vs 5.9;p = 0.01). At 12 months, had a minor number or readmissions without statistical significance. No significant differences were in mortality or quality of life. Survival free from readmissions curves shows that probability of readmission was lower in the intervention group (p = 0.02) with hazard ratio 0.51 (95% confidence interval, 0.27-0.95).

Conclusions: An educative intervention at discharge in an elderly population with heart failure improves treatment compliance, reduces readmissions and hospitalization days, without differences in quality of life.