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Heart failure (HF) is the most frequent reason for hospitalization of older individuals in North America. Despite the availability of evidence-based therapy and comprehensive disease management programs, readmission rates for recurrent HF remain high, particularly within the first 3 months. Frequent monitoring, adequate health care resources, social support and accessibility to care, may be limited for older HF patients. Engagement in self-care, including adherence to prescribed therapies and recognition of HF symptoms, is key to HF management. Despite the known importance of self-care, HF patients do not consistently engage in appropriate behaviours. Many factors may affect the older HF patient’s ability to self-care, including health literacy, cognitive impairment and the absence of an informal caregiver (Carepartner/CP). Previous studies demonstrate that up to 80% of older HF patients without dementia, show evidence of mild cognitive deficits (as measured by the Montréal Cognitive Assessment-MoCA) at hospital discharge, and poor self-care ability (as measured by Self-Care HF Index/SCHFI, 0-100). Cognitive deficits may lead to difficulties in self management of HF symptoms after discharge, potentially increasing the risk of hospital readmission. Involvement of a CP can provide important support to patients with HF. Randomized controlled trials have demonstrated that the involvement of CPs can significantly improve clinical outcomes in patients with stroke and dementia.
We have completed a pilot RCT evaluating a multi-component intervention to enhance HF care after discharge, with or without the support of a CP for the patient. The 3-month intervention included: (a) a talking scale, (b) a diuretic decision support tool, (c) literacy sensitive HF home based education sessions and (d) a HF specific hospital discharge summary sent immediately to the primary care physician. Self-care was assessed using the SCHFI for the patient and CP; HF knowledge explored with the Knowledge Assessment questionnaire; CP burden measured with the modified Oberst scale; medication adherence with the Medication Possession Ratio.
Patient enrolment started in October 2012 with last follow up visit planned for July 2014. From 3 hospital sites in Hamilton, ON, we recruited 85 patients, mean age 76 years (SD 9), 49% male, mean left ventricular ejection fraction 46% (SD 16). Preliminary results show improvement in the management subscale of SCHFI, for patients and CPs (Table 1).
Preliminary results demonstrate that a simple multi-component intervention after hospital discharge, significantly improves self-care. Final results will be reported.