Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting

Abstract

Background: Heart failure (HF) patients living in rural areas have a lack of HF knowledge and poor self-care because of limited medical care access. Multidisciplinary education to improve self-care behavior is indispensable for such patients. The present study evaluated whether intensive inpatient education improved outcomes of hospitalized HF patients in a Japanese rural setting.

Methods: An inpatient HF management program based on multidisciplinary team intervention was applied to hospitalized HF patients in a Japanese rural area. We defined patients treated within the program from May 2009 to April 2011 as the intervention group (n = 144), and those treated with the usual care from May 2006 to April 2009 as the usual care group (n = 133). The composite endpoints of HF hospitalization and all-cause mortality were compared between the two groups.

Results: Compared with patients in the usual care group, those in the intervention group more often received the optimal interventions such as discharge use of β-blockers, cardiac rehabilitation, pre-discharge diagnostic tests, and multidisciplinary intensive education including nurse-led patient education, pharmacist's medication teaching, and dietitian's nutritional guidance (all P < 0.05). The incidence of the composite endpoints significantly decreased after introducing the program (P < 0.001). Among a number of interventions, multidisciplinary intensive education was the most effective intervention to improve the primary outcome (P < 0.001).

Conclusions: Multidisciplinary intensive education is a key strategy for helping improve the outcome for Japanese HF patients in a rural setting. Our data may give a positive impact on the improvement of healthcare system in Japan.

Figure 1

Cumulative event curves for the composite end points for patients in the usual care and intervention groups. Cumulative event curves were adjusted for age and sex. HR: Hazard ratio. CI: Confidence interval.

Figure 2

Adjusted cumulative event curves for the composite end points among three groups according to the number of education interventions received. Cumulative event curves were adjusted for age, sex, left ventricular ejection fraction, discharge use of β-blockers, discharge use of angiotensin-converting enzyme inhibitors, cardiac rehabilitation, pre-discharge assessment of echocardiography/B-type natriuretic peptide level, and follow-up with the cardiologists. HR: hazard ratio. CI: Confidence interval.

Figure 3

The effect of each medical and non-medical intervention on the primary outcome. Cox hazard model was adjusted for age and sex. ACE-I: Angiotensin-converting enzyme inhibitor. ARB: Angiotensin receptor blocker. MR: Mineralocorticoid receptor. PCI: Percutaneous coronary intervention. CABG: Coronary artery bypass graft. BNP: B-type natriuretic peptide.

Figure 4

In-hospital management in the usual care and intervention groups, including pharmacological and non-pharmacological intervention (A), and educational intervention and discharge assessment and planning (B). ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; MR, mineralocorticoid receptor; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; CRT, cardiac resynchronization therapy; ICD, implantable cardiac defibrillator; CPAP, continuous positive airway pressure; ASV, adaptive servo ventilation. BNP: B-type natriuretic peptide. *care service including nurse home visit or day care service.

Figure 5

The distribution of education types received by patients in the usual care and intervention groups.