Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3007 — Evidence-Based Education for Heart Failure

Boren SA (VA - Columbia, MO) , Gunlock TL (VA - Columbia, MO), Wakefield BJ (VA - Columbia, MO)

Objectives:
The evidence-base of the necessary components of self-management education programs is very thin. Each program is comprised of a distinct bundling of content offered and outcomes measured. To be successful, these programs must be focused. The objective of this study is to identify the heart failure program education content and techniques that lead to successful self-management and improved outcomes.

Methods:
We searched in MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials, as well as reference lists of included studies and relevant reviews. Eligible studies were randomized controlled trials evaluating congestive heart failure self-management education programs that included outcome measures. Two of the investigators independently abstracted descriptive information, education content topics, and outcomes data. The educational content items from all studies were clustered to create an education topic list. The outcomes of the studies were clustered to create a comprehensive description of outcomes that were measured and if the outcome was significant or non-significant as indicated in the original article. A univariate analysis was conducted to see if interventions including the educational topic were more likely to succeed than interventions lacking the topic.

Results:
A total of 5589 patients participated in the 27 chronic heart failure studies. Congestive heart failure education programs incorporated 20 topics in the categories of knowledge and management, social interaction and support, fluids, and diet and activity. A total of 117 outcomes were measured in the studies. Fifty-eight (50%) of the outcomes demonstrated significant improvement in at least one study. Univariate analysis revealed that educational interventions containing the education topic of sodium restriction were more likely to decrease mortality (p=.065), appropriate follow-up with provider were more likely to decrease cost (p=0.099), management and recognition of worsening functioning were more likely to make social functioning worse (p=0.096), and fluids were more likely to increase hospitalization (p=0.014) and cost (0.099).

Implications:
Education is one of the most powerful healthcare interventions. We need to invest in a better understanding of how education works to help improve the health of people with chronic illness.

Impacts:
Applications intended to inform patients should be based on scientifically sound evidence.