Can we improve quality of life in heart failure - results of the national educational study

Abstract

Background: Heart Failure (HF) is serious, disabilitating condition, with very negative impact not only on patients' everyday activities but also quality of life (QOL). In general this population is characterized by low QOL as in the other chronic conditions. Some of the costly disease management programmes substantial improved it. However it is unknown if simple educational program may improve QOL in HF pts. Aim: The aim of this study was to evaluate the effectiveness of teaching session with handed over educational material with respect to QOL. Methods: Multicenter national study assessingHF subjects from ambulatory care. Population. 617 pts with HF from general practitioners from 9 districts in Poland randomized to: educational group (E) n=270 and control group (C) n= 347. E group participated in a single educational session. During the session pts were informed about theoretical and practical aspect of HF management and methods of preventions. Pts. received HF brochures and weight monitoring training. C group remained under regular care from GP. QOL was assessed by WHO-bref questionnaires, including 4 domains. After 6 months participants attended control visit with repeated quality of life evaluation. Results: There were 57% vs. 53% of males in E and C, mean age in both groups was 66.9 vs. 69.3 yrs., civil status- married 65% vs. 59% of patients, living alone 11,7% vs. 18.9 %, level of education primary or vocational 58% vs. 58%, percentage of pts. on disability pension (among those who should be professionally active) 63% vs. 63%. Clinical status - there were 46% vs. 55% of pts. having at least 3 comorbidities (3COM) and most of subjects were in NYHA classes I/II 74% vs 69%. Pharmacotherapy: ACEI 89% vs. 88%. BB 76% vs. 77%. Baseline QOL assessment in E and C: physical domain (PHD)12 vs 12 (max.35 points), psychological domain (PSD) 13 vs 14 (max.30) social domain (SOD)14 vs 14 (max.15) environmental domain (END) 13 vs 13 (max.40). After 6 months of follow up in E and C: PHD 12 vs 12, PSD 13 vs 14, SOD 13 vs 14, END domain 13 vs 14. Both groups differed only with respect to END at the baseline and at follow-up. Analisis of trends over time revealed, that there were no changes wthin the group (at baseline and at the end) or between the groups with respect to PHD, PSD, SOD. However there was an improvement withinEND within E andC(p=0,01). Nevertheless both trends were alike (p=ns) with no difference between the groups. Conclusion: HF pts have very low QOL. Simple educational intervention regarding practical approach to Hf management did not results in QOL improvement.