Running head: CONGESTIVE HEART FAILURE PATIENTS

Education Program for Congestive Heart Failure Patients

Kayleigh Shelton
University of South Florida

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

Abstract
Clinical Problem: Congestive heart failure is a very complicated disease to live with. When
patients leave the hospital with this diagnosis the basic education given to them is not enough to
properly motivate and sustain proper self-care at home.
Objective: To determine if supplemental education beyond the basic discharge education
provided by the nurse is needed to improve self-care at home. PubMed and the CINAHL were
used to locate articles containing RCTs testing additional education for heart failure patients and
their effects. The key terms used to search for these articles were heart failure patient teaching,
additional teaching for heart failure patients, assessing discharge teaching for heart failure
patients, and RCT for patient education in heart failure.
Results: All three sources recommend additional education from the basic discharge patient
teaching, such as, pamphlets, extra education, and follow-ups. In all three studies the patients
with extra education demonstrated signs of better home care and in some cases overall better
quality of life.
Conclusion: Overall providing heart failure patients with additional teaching and follow up care
improves heart failure patients ability to take care of themselves at home and to really give them
the start they need to transition from the hospital to caring for their disease at home. More studies
should be done to narrow down the most effective ways of teaching these patients and what
topics to focus most on.

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

Education Program for Congestive Heart Failure Patients

According to the CBC, over five million people suffer with heart failure in the United
States (Yancy, Jessup, & Bozkurt, 2013). Approximately one half of people diagnosed with heart
failure lose their lives within 5 years of their diagnosis (Yancy, Jessup, & Bozkurt, 2013). Five
years is not a long time at all, and programs need to be executed to help patients maintain their
lives when living at home with this disease. Once treated in the hospital the patients are sent
home to fend for themselves. It is a nurses responsibility to make sure they are sent home with
all the information and sources they may need to take care of themselves at home. In people
with congestive heart failure how does participating in disease specific educational programs
after discharge compared to solely a brief standard discharge patient teaching improve the
patients self care at home in a six month period?
Literature Search
PubMed and CINAHL were used to locate the RCTs used to describe the different types
of supplemental education for heart failure patients and their effects on their self care at home.
The key terms used to locate these articles were heart failure patient teaching, additional teaching
for heart failure patients, assessing discharge teaching for heart failure patients, and RCT for
patient education in heart failure.
Literature Review
The clinical recommendation from The American Heart Association for education of
heart failure patients requires understanding of how to manage symptoms and weight, how to
restrict their sodium intake, take medications properly, and promote physical activity (Yancy,
Jessup, & Bozkurt, 2013). Disease management programs are even recommended by The
American Heart Association, but not required (Yancy, Jessup, & Bozkurt, 2013).

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

Kutzleb & Reiner tested how educating the patients on self care management influences
their ability to function with their disease at home and their overall QOL (2006). They evaluated
the improvement of home care and QOL in patients who are taught about life style modification,
monitoring daily weights, proper use of medications, and proper dieting with HF (Kutzleb &
Reiner, 2006). The experiment called for 10 patients to receive basic discharge education and 13
patients to receive nurse- directed comprehensive disease management education along with a
follow up call once a week (Kutzleb & Reiner, 2006). This study used an Analysis of Covariance
to compare the home care and QOL in the two groups after a 12-month period (Kutzleb &
Reiner, 2006). The test revealed that the QOL in the intervention group improved a great amount
F= 3.569 and p= 0.00, health and function showed F= 3.995 and p= 0.003, social and economic
values were F= 14.109 and p= 0.000, psychological and spiritual values were F= 13.212 and p=
0.000 (Kutzleb & Reiner, 2006). Functional capacity was only slightly impacted F= 0.228 and p=
0.949 (Kutzleb & Reiner, 2006). Some things this experiment executed well was that they look
at so many different aspects to evaluate their QOL and self care at home. For example they look
at social and economic, psychological, and spiritual values (Kutzleb & Reiner, 2006). It was also
great that they did a full health assessment before and after the experiment to get a good baseline
on the patients health. Subjects were randomly assigned to their groups, but the control group
was aware they would not be getting the supplemental teaching (Kutzleb & Reiner, 2006).
Yu, Chair, Chan, & Choi performed an experiment to see how providing heart failure
patients with an education program directed at their disease improves their QOL and overall self
care at home (2013). They took 160 heart failure patients and split them into an intervention
group and a control group (Yu, Chair, Chan, & Choi, 2013). The intervention group received an
educational heart failure booklet along with follow up phone calls (Yu, Chair, Chan, & Choi,

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

2013). After four months the results were interpreted though an independent t-test and a
generalized estimating equation (Yu, Chair, Chan, & Choi, 2013). The results showed a decrease
in symptoms with a p value < .01, an increase in function with a p value of <.01, an increase in
quality of life with a p value of < .05, and no effect of hospital visits (Yu, Chair, Chan, & Choi,
2013). Using an experiment from another country can be concerning if their standard of care is
different than here in the United States. Another issue is that they only did their study for four
months (Yu, Chair, Chan, & Choi, 2013). They did include a lot of different exclusionary
guidelines for their participants, which make the study more reliable (Yu, Chair, Chan, & Choi,
2013). For example, they excluded people with coexisting conditions that could skew the results
(Yu, Chair, Chan, & Choi, 2013). They excluded people who didnt speak Mandarin, which
eliminates language barriers (Yu, Chair, Chan, & Choi, 2013). They also used a lot of
participants for this study to get more accurate results. In this experiment the control group knew
they were only receiving standard care (Yu, Chair, Chan, & Choi, 2013).
Koberich, Lohrmann, Mittag, & Dassen performed an experiment to examine the effects
of patients with heart failure who received nurse- based education upon discharge as well as
follow up phone call support (2015). This experiment also looks at patients QOL and self care at
home after being discharged and diagnosed with heart failure (Koberich, Lohrmann, Mittag, &
Dassen, 2015). They took 52 heart failure patients for their control group and 58 heart failure
patients for their independent group where they were given an extra teaching session by a nurse
on how to manage their disease at home and follow up phone support (Koberich, Lohrmann,
Mittag, & Dassen, 2015). QOL and self-care standards were measured through questionnaires
before and after the test was implemented (Koberich, Lohrmann, Mittag, & Dassen, 2015). For
this experiment they should have done it longer than 3 months for better results. Although, the

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

use of questionnaires is a good choice for this study; they are a good way to see how the patients
were affected by the experiment and to record their thoughts. They also used a decent amount of
participants for this experiment. The control group was aware of the experiment and that they
were the control, but the participants were randomized (Koberich, Lohrmann, Mittag, & Dassen,
2015). The questionnaires reported an increase in self- care for the intervention group but no
change in QOL in either group. P= 0.006 (Koberich, Lohrmann, Mittag, & Dassen, 2015).
Synthesis
All three of the studies measured QOL and self care at home in patients with heart failure.
In all three self care was increased by the extra education provided to them on heart failure. All
of the experiments provided a follow up phone call with their additional teaching. All of the
experiments were RCTs and had a similar purpose is proving that additional education is needed
for heart failure patients when they are discharged.
In the Kutzleb & Reiner study, they gave the independent group a phone call once a
week and a comprehensive education class on heart failure for one year in Germany (2006).
They didnt use too many participants, and measured their outcomes using an Analysis of
Covariance (ANCOVA) (Kutzleb & Reiner, 2006). They excluded patients whose conditions
were new or acute, under the age of 18, surgery or implantations (Such as CABG or ICD), life
expectancy less than 3 months, involvement in another study, or did not speak German (Kutzleb
& Reiner, 2006). They also looked at QOL and self care by examining different aspects of the
patients life such as: health and function, social and economics, psychological and spiritual and
functional capacity (Kutzleb & Reiner, 2006). In this study the QOL was increased in the
independent group tremendously but functional capacity or self-care was only increased by a
little bit (Kutzleb & Reiner, 2006).

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

In the Yu, Chair, Chan, & Choi RCT the additional education was given in the form of a
booklet and follow up phone calls (2013). This experiment was only given over four months and
it was done in China (Yu, Chair, Chan, & Choi, 2013). This one also showed an increase in QOL,
decrease in symptoms, an increase in function, but no effect on hospital visits (Yu, Chair, Chan,
& Choi, 2013).
Lastly, the Kutzleb & Reiner RCT provided the independent group with an educational
class provided by a registered nurse and a follow up phone call (2006). This study was only over
a course of three months (Kutzleb & Reiner, 2006). The results came from questionnaires given
before and after the study was done (Kutzleb & Reiner, 2006). This study showed an increase in
self-care but no change in QOL (Kutzleb & Reiner, 2006). Analysis of the effectiveness of the
program showed a decrease in symptoms with a p value < .01, an increase in function with a p
value of <.01, an increase in quality of life with a p value of < .05, and no effect of hospital visits
(Kutzleb & Reiner, 2006).
The education given improves patient care in and out of the hospital. Providing any type
of additional education empowers the patient to maintain his or her own self-care at home. The
additional education allowed for patients to ask questions that they may have had or havent
thought of at the time of discharge. The follow up calls allow for patients to ask specific
questions after they get home and see what type of symptoms or aspects of self care they may be
struggling with. More studies should be done to make it clear exactly which aspect of the
additional teaching helped them the most and what questions or topics the participants needed
the most teaching on.

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

Clinical Recommendations
Based on the information provided by the trials, it seems as if the additional education for
heart failure patients make enough of an improvement in home care for hospitals to start
implementing it in their discharge care. It seems as if the follow up phone calls were key
components in the improvement of care at home. The experiments where they provided
additional classes also warranted results. The questionnaires can also come in very good use in
figuring out what types of subjects the patients need more teaching on and what type of help
applies to the patient specifically. Overall, upon discharge the nurse should give a pretest
questionnaire to see what topics the patient struggles with concerning their disease, do her basic
teaching, and then give the patient another questionnaire to test their learning and survey for
additional questions. A follow up class should be provided a week or so later to make sure the
patients are functioning well at home and to answer any new questions. Finally, follow up phone
calls should be made once a month to survey the patients self care and wellbeing at home, and
answer any questions they may have later on down the line.

References
Koberich, S., Lohrmann, C., Mittag, O., & Dassen, T. (2015) Effects of a hospital-based

EDUCATION PROGRAM FOR CONGESTIVE HEART FAILURE PATIENTS

education programme on self-care behaviour, care dependency and quality of life in

patients with heart failure- A randomised controlled trial. Journal of Clinical Nursing.
24, 16431655. doi: 10.1111/jocn.12766
Kutzleb, J., & Reiner, D. (2006). The impact of nurse-directed patient education
on quality of life and functional capacity in people with heart failure. Journal of the
American Academy of Nurse Practitioners, 18(3), 116-123. doi:10.1111/j.17457599.2006.00107.x
Yancy C. W, Jessup M, Bozkurt B. (2013) ACCF/AHA Guideline for the management of
heart failure: A report of the american college of cardiology foundation/american heart
association task force on practice guidelines. J Am Coll Cardiol. 2013, 62, 147- 239. doi:
10.1016/j.jacc.2013.05.019.
Yu, M., Chair, S. Y., Chan, C. W., & Choi, K. C. (2015). Care of patients with
cardiovascular disorders: Heart failure: A health education booklet and telephone followups can improve medication adherence, health-related quality of life, and psychological
status of patients with heart failure. Heart & Lung - The Journal Of Acute And Critical
Care, 44, 400-407. doi:10.1016/j.hrtlng.2015.05.004