Counseling Falls Short for Heart Failure Patients

More effective strategies are needed to help patients with heart failure manage their condition, new research shows.

Patients with mild to moderate heart failure may need more than just counseling and education to adhere to their medications and ward off future cardiac events, according to a study published in the September issue of the Journal of the American Medical Association.

Researchers involved in the Heart Failure Adherence and Retention Trial (HART) found that a combination of group counseling and reading materials designed to teach self-management techniques was no more effective than educational handouts alone in preventing hospitalization or death.

The results came as a surprise to the study’s authors, who believed that counseling would provide patients with the additional support needed to follow their physicians’ orders. “To enable patients to be proactive, we reasoned that heart failure education should be augmented by training in self-management skills to help patients implement the education. This hypothesis was not supported,” they wrote.

As part of the study, 902 patients with mild to moderate heart failure participated in 1-year treatment programs. Half the patients attended 18 2-hour group counseling sessions led by health professionals and received heart failure tip sheets published by the American Heart Association at each session. Patients in this group also learned self-management techniques, such as tricks to remember medication, strategies for coping with stress, and ways to seek emotional support from friends and family.

Patients in the education-only group were given the same 18 tip sheets by mail and received regular phone calls to ensure they understood the material provided.

In both groups, approximately 40% of patients experienced cardiac events that resulted in hospitalization or death within the 2- to 3-year follow-up period. No significant differences were observed between the 2 groups in measures of fitness, heart rate, respiratory rate, blood pressure, body mass index, quality of life, emotional support, or purpose in life.

The results do not suggest counseling should be discounted as ineffective; rather, it should be refined and supplemented by other means, according to the report. The researchers cite remote patient monitoring and individualized counseling for specific patient populations as approaches that may have a greater impact on clinical outcomes.

“Given the epidemic of heart failure burdening the health care system, identification of innovative and cost-effective approaches to outpatient management is urgently needed,” they concluded.

For other articles in this issue, see:

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