Effect of formal heart failure education and support group sessions on the perceived quality of life in patients living
with heart failure.
Theresa Heyborne, RN, BSN UCH Advanced Heart Failure Clinic
Background
UCH organized multi-disciplinary Heart Failure Task Force in 2010. Specific goals of the Task Force include finding ways to ensure:
Medication management post-discharge. This is defined as: Patients must understand the purpose of the medications they are taking and be able to get them. Symptom management. This is defined as: Patients should be able to recognize the signs of their condition worsening.
Heart Failure University was created to meet these stated goals.
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Background (cont.)
Despite the assumption that education will improve knowledge and self-care behaviors, the literature shows conflicting data as to the exact benefit of this education. There is also no consensus as to the best manner in which this education should be delivered.
Review of Literature
Boyde
(Educational Interventions for Patients with Heart Failure: A Systematic
Review of Randomized Controlled Trials. Journal of Cardiovascular Nursing 2011)
performed a review of 19 studies from 1998 to 2008 that included education by nurses to patients with Heart Failure. Of these 19 studies, 15 demonstrated a significant effect from their intervention in at least one of their outcome measures. 12 studies looked at QOL and only 2 found significant improvement after intervention.
Review of Literature (cont)
Bekelman (Giving Voice to Patients and Family Caregivers Needs in Chronic
Heart Failure: Implications for Palliative Care Programs. Journal of Palliative Medicine
performed a qualitative study for Palliative Care purposes and found patients with CHF wanted information early and throughout the course of their illness to help understand and plan for their futures. They requested the information come from health care providers using a team approach with the patient and their family.
2011)
Review of Literature (cont.)
Doughty
(Randomized, Controlled trial of integrated Heart Failure Management.
studied 197 patients who had been admitted with Heart Failure. They compared a control group of usual therapy to a group who received directed heart failure education in addition to usual care. They found the intervention group had improved QOL and reduced total hospital admissions. Peterson (Health Literacy and Outcomes Among Patients with Heart Failure. JAMA 2011) studied health literacy as an indicator for all cause mortality and all-cause hospitalization. She found low literacy was significantly associated with higher all-cause mortality but NOT hospitalizations.
European Heart Journal 2002)
Purpose
Heart Failure University (HFU) was established with the goal of increasing patients self-care abilities through education and discussions between providers, patients and care partners. A study assessing the participating patients perceived Quality of Life (QOL) was designed to determine if by attending this University the patient would note any change in their QOL.
Methods
A series of five free standing classes was designed. ~ A multidisciplinary team was formed. The chairman is a HF nurse. Team members include: a pharmacy professor, an Advanced HF physician, a second HF nurse, a nutritionist, an exercise physiologist and the Care Coordination Department director. ~ Administration and Marketing actively helped the chairman to procure a meeting space, design advertising flyers and e-mail invitations to 500 UCH patients with the diagnosis code 428.0 ~ UCH Heart Failure web site was updated to assist patients obtain information and find HFU invitation.
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Methods (cont.)
Pre and Post education survey
~All patients attending Heart Failure University were asked if they were willing to complete a survey to assess the effect this education will have on them. Patients were told they would receive a second, final survey after they completed as many classes as they choose to attend. Surveys would be sent to them by the manner they preferred and based on the address they provided in the initial survey (e-mail or USPS). ~ Surveys consisted of 23 validated questions by the Kansas City Cardiomyopathy Questionnaire (KCCQ), 4 questions on medications and ease of obtaining medical care and 5 demographic queries. ~ The follow up survey included the KCCQ and two qualitative questions on information learned and suggestions to improve future offerings. ~ The study was classified as a Quality Improvement study and did not need to receive COMIRB approval.
Results
28 patients completed a pre-intervention survey Of those patients, 16 patients completed both pre and post intervention surveys No improvement was statistically significant for any measurable variable
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Demographics
Of the 28 participating patients:
# daily different medications
13 people were taking 3 to 6 different meds 6 people were taking 7 to 10 different meds 9 patients were taking more than 10 different meds 6 people said they were nearly always compliant with taking their meds 22 people said they were always compliant with taking their meds 2 people said moderately difficult 1 person said somewhat difficult 8 people said not very difficult 14 people said no problem at all
Reported compliance with medication administration:
How difficult is it for you to access medical care:
Demographics (cont.)
Have costs been a burden to you over the last year?:
1 person said cost was a severe burden. 5 people said cost was a moderate burden. 3 people said cost was somewhat of a burden. 5 people said cost was a little burden. 14 people said cost was no burden. 4 patients live alone 24 live with someone else More than 10 years: 7 patients 3 to 9 years: 6 patients 1 to 2 years: 7 patients Less than one year: 5 patients Unknown: 3 patients
Living situation:
Time since they were diagnosed with Heart Failure:
Physical Limitations
100 90 80 70 60 78.22916667 79.633125
Mean
50 40 30 20 10 0 Pre Post
0 = Complete physical limitation; 100 = No limitation
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Symptom Stability
100 90 80 70 60
Mean
64.0625 56.25
50 40 30 20 10 0 Pre Post
100 = much better; 50 = no symptom change; 0 = much worse
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Symptom Frequency
100 90 80 70 60 78.25520833 74.78125
Mean
50 40 30 20 10 0 Pre Post
>3 x week = 31.5; < 1 x week = 68.75; never = 100
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Symptom Burden
100 90 80 70 60 78.64583333
76.04
Mean
50 40 30 20 10 0 Pre Post
100 = no symptoms; 0 = extreme symptoms
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Self Efficacy
100 90.625 90 80 70 60
Mean
92.96875
50 40 30 20 10 0 Pre Post
100 = Know what to do for HF symptoms & how to seek help.
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Quality of Life
100 90 80 69.79 70 60
Mean
65.10416667
50 40 30 20 10 0 Pre Post
0 = not satisfied with life; 100 = no limitations/ very satisfied
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Social Limitations
100 90
80 73.828125 70.963125 70
60
Mean
50
40
30
20
10
0 Pre Post
0 = life is severely limited by HF; 100 = HF has not limited life
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Overall Summary
100 90 80 70 60
Mean
73.828125
70.963125
50 40 30 20 10 0 Pre Post
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Qualitative Results
Participants were asked, Name at least one fact that you learned from attending Heart Failure University that may positively impact your life.
Responses included: ~ CHF wasnt my fault. Information on end-of-life such as the MOST form will help lessen the pressure and guilt on my son when I expire Overall a better understanding of what I can do to help myself try to maintain my current level of CHF.
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Qualitative Results
~ It was helpful to understand how individualized the symptoms and treatments need to be for heart issues. ~ I learned to keep my head up. Heart Failure can be managed and dealt with. ~ I learned how important adherence to meds is. ~ I met people just like me and we shared each others thoughts, concerns, fears and hope. I didnt feel so alone after taking your class. ~ I learned Heart Failure is not necessarily a death sentence.
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Limitations
The limitations of this study included: The participants were a self-selected group that had a higher baseline perceived QOL than that of at least one previously published study group, despite having similar physical health. The sample size of the study group was small. The time necessary to complete the study did not allow for long term benefits to be measured.
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Future Directions
Heart Failure University will continue indefinitely at the University of Colorado Hospital or until patient participation ceases. Future studies will continue to look at aspects of self-care that can be modified and measured.
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Acknowledgements
I would like to thank the following people for their enthusiastic support and exceptional help in both the success of Heart Failure University and the development and analysis of this research study: Lorna Prutzman, Larry Allen, Robert Page, Mary Thompsen, Shannon Walker, Jennifer Holder, Leslie Meyer, JoAnn Lindenfeld, Gene Wolfel, Harri Brackett, Matthew Stoeffel, Amanda Nenaber, Colleen Rohrer, Regina Fink and Rick Plummer.
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