Education as a Heart Failure Intervention: What Providers Taught Patients in One Hospital Setting

ABSTRACT

            Heart failure (HF) affects approximately 5.7 million people in the United States (US) and by 2030, projections show a 25% increase in prevalence (Go et al., 2012, 2013).  For patients with HF, there are few solutions to this highly morbid, disabling, and costly disease.  To reduce the risk of complications and disease progression, patients hospitalized with HF require education prior to discharge.  There is compelling evidence for utilizing educational instruction that includes evidence-based guidelines from the American Heart Association (AHA).  This study examined what HF information was provided to patients by health care providers (HCPs), what instructional content taught went beyond the AHA Guidelines, and what HF education expert providers viewed as critical for their patients to receive.  No studies were found that compared and contrasted these AHA Guidelines with the instructional content provided to hospitalized patients.  Using naturalistic inquiry, 10 HF patients (New York Heart Association functional class of III or IV) and 161 HCPs were observed.  Results showed that not all AHA topics were consistently covered; 70% (n = 10) patients received less than one hour of instruction, compared to the AHA standard of 60 minutes; AHA Guidelines did not include instructional content on the patient’s current plan of care which nearly equaled the time spent on AHA topics; brochures and handouts were rarely used and the topics within these materials were not inclusive of AHA standards; a sequence of education provided on medications, symptom recognition, diet, and follow up care, was congruent with AHA Guidelines and reinforced by the expert panel; and physicians and nurses delivered the most instruction (AHA or non-AHA).  The findings of a study of this nature are not generalizable yet patient and organizational outcomes are compromised without effective and efficient HF instruction.  Recommendations included: to provide peer reviewed feedback to HCPs on the appropriateness in teaching to literacy level, cultural and socio-economic realities, and where the patient will be discharged to (home, another health facility, etc.); to incorporate patient instruction into curricula and clinical experiences of health professional schools; and to include instruction in each and every patient – provider interaction.  The results of this study should create an impetus for other comprehensive patient education instructional strategies.