Intensive patient education by specialized nurses improves quality of life and self-management skills in patients with heart failure in a multicentre randomized controlled trial

Heart failure (HF) remains a major public health issue affecting daily living and health-related quality of life (HRQoL) largely due to the risk of rehospitalizations, some of which could be avoidable through an improvement in self-care management strategies.

The EduStra-HF study aimed to assess an intensive patient-education programme conducted by specialized nurses in patients discharged from hospital after an episode of acute HF.

Patients admitted for acute HF in six cardiology departments were randomly assigned to intervention, consisting on an intensive patient education follow-up leaded by HF specialized nurses, or usual care. Patients in the intervention group received 6 telephone calls, 2 home-visits and regular advice about their disease by text messages throughout their one-year follow-up. Primary endpoint (comparison of first HF rehospitalization between the two groups) has been previously published. This study focuses on pre-specified secondary endpoints: HRQoL, patients’ knowledge and skills for HF daily management and rate of guideline-directed medical therapies (GDMT).

Between 2017 and 2022, 318 patients were enrolled in the trial and 297 could be included in the intention-to-treat analysis; 144 patients were randomly assigned to the intervention group and 153 to usual care. Mean age was 72.4 years (SD 13.2), 63.6% of patients were men. Median left ventricular ejection fraction was 38% (interquartile range 25–51).

HRQoL assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ-15) increased significantly between baseline and one year. The increase was notably greater for the social limitation score (43.7 vs 61.4; p<0.0001), whereas no significant difference was observed in the usual care group. The mental score of the 12-item short-form (SF-12) survey also increased in the intervention group between baseline and 1 year (41.3 vs 46.3; p=0.0008), whereas no difference was found in the usual care group.

The intervention improves significantly in comparison with usual care the daily surveillance of HF alert signs (63.9% vs 29.4%; p<0.0001), understanding of medications (complete understanding, 51.3% vs 17.7%; p<0.0001) and compliance to physical activity recommendations (total compliance, 86.6% vs 55.9%; p<0.0001).

Regarding GDMT prescription rates, 73% of patients in the overall population received less than 50% of the expected dose at one year. The result on the primary endpoint was neutral.

The EduStra-HF study showed a significant lasting improvement in HRQoL, despite the low rate of GDMT prescription observed. Patients’ mental well-being, knowledge and self-care management increased significantly in patients discharged after an acute HF episode who benefited from an intensive patient education programme conducted by HF specialized nurses.