The role of a structured patient education programme in the complex care of patients with heart failure

Abstract Introduction Structured patient (pt) education programme (PEP) and teaching self-care (SC) management are recommended for all pts with heart failure (HF) in accordance with the European Society of Cardiology (ESC) Guidelines. However, the implementation of PEP in the everyday practice, and the analysis of its impact on pts’ knowledge and SC can be difficult. Aims To assess the impact of a structured PEP on the knowledge of HF pts about the disease, recognition of emergency conditions and effect on SC. Methods The Working Group (WG) on HF of our tertiary cardiology referral center organised an interactive PEP led by HF specialists and a specialist HF nurse, for pts hospitalised for HF between 01.06.2023 and 31.08.2024. Pts and their relatives participated in an interactive lecture about the main characteristics of HF, drug therapy, SC and recognition of emergency conditions. Before and directly after the PEP, pts’ knowledge was evaluated with a 11-question simple choice questionnaire developed by our WG on HF. 3 months after the PEP, the same questionnaire has been assessed as well as the nine-item European HF SC Behaviour Scale (EHFScB-9). The total score of the EHFScB-9 was translated into a 0-100 point scale (45-EHFScB-9 total score*2.777), with a score ≥ 70 indicating adequate SC according to the literature. The predictors of optimal SC management thus defined were analysed with logistic regression analysis. The changes in the pts’ SC responsibilities were also examined before the PEP and at 3 months. Pt feedback on the PEP was also investigated. Results The data of a consecutive group of 164 pts (male: 78%, age: 56 47-64 years, de novo HF: 37%, LVEF: 27 20-35%, NT-proBNP at discharge: 1578 600-2983 pg/mL) participating in the PEP were evaluated. In the effect of the PEP, pts’ knowledge significantly improved as measured by the 11-question questionnaire (9 8–10 vs 11 11-11 points, p0.001; before PEP vs directly after PEP), which sustained stable at 3 months (9 8–10 vs 11 11–11 points, p0.001; before PEP vs 3 months of follow-up). The median total score of the EHFScB-9 at 3 months was 13 11-16 points, which meant a median score of 89 81-94 points on the 0-100 point scale. 86% of the total cohort reached ≥70 points on the EHFScB-9, indicating optimal SC. Age, gender, level of education, family involvement in PEP, comorbidities, "de novo" HF, NT-proBNP, and LVEF did not influence the adequate SC. The application of SC activities (measurement of blood pressure, pulse, weight and fluid intake) improved significantly (p0.001), practiced daily to 82-96% of the pts at 3 months. The majority of pts found the PEP useful. Conclusions According to our results, structured, complex PEP significantly improved pts’ knowledge on HF and SC, which persisted long-term. Based on the EHFScB-9 86% of pts reached optimal SC, which was achieved regardless of patient characteristics, underscoring the wide applicability of PEP.