Patients with heart failure education: the effectiveness of interventions
Authors: Paleckiene R , Macijauskiene J , Zaliaduonyte D , Jasukaitiene E 
Published: October 2021

Abstract

Introduction
According to the data of Lithuanian Hygiene Institute in 2019 the incidence of heart failure (HF) was about 89 300 cases in Lithuania and 1/3 of them had active in-hospital treatment. (1). Sherwood and his colleagues determined that the development of skills improves the quality of life (QoL) for patients with HF; it also affected the decline of the NT-pro BNP significance (2). To prevent worsening of HF and its complications such as severe arrythmias and patients death, it's important not only the prescribtion of optimal medical treatment, but also teaching the patient how to recognize symptoms of worsening HF and adjusting modified risk factors (3,4).

Aim
To determine the impact and effectiveness of a specialized monitoring program for HF patients.

Methods
We have analyzed the data of 82 patients discharged from the Department of Cardiology of Lithuanian University of Health Sciences in 2017–2018 after worsening of HF. All patient participated in the long-term training and monitoring program and had 4 visits at cardiologist and HF nurse in out-patient clinic. Statistical method with IBM SPSS Statistics version of 20.0 program was applied in the analysis. Continuous data are presented as mean ± SD when normally distributed and as median (interquartile range) when not normally distributed. Continuous variables were compared with Student's t-tests or Wilcoxon tests, as appropriate.

Results
The mean age of the study population was 60.63±11.9 years. 72 (87.8%) persons were male. AH was presented in 60 (73.3%), dyslipidemia in 48 (58.5%) patients. 31 (37.8%) patient had history of myocardial infarction, 14 (17.1%) - of diabetes mellitus, 11 (13.25%) of cerebrovascular stroke and atrial fibrillation and/or flutter was presented in 44 (53%) patients. 16 (19.5%) were smokers and 30 (36.6%) - alcohol users. Clinical symptoms did not change statistically significant through the follow-up period, only heartbeat sensing decreased (p&lt;0.001). Evaluating laboratory parameters statistically significant decreased uric acid 417.50 μmol/l [350.50–495.00] v.s. 384.00 μmol/l [350.50–495.00], p&lt;0.051), urea 6.80 mmol/l [5.0–9.9] v.s. 5.9 mmol/l [4.7–7.7], p&lt;0.052) and bilirubin direct 2.8 μmol/l [1.4–3.7] v.s. 2.1 μmol/l [1.3–3.5], p&lt;0.001). NT-pro-BNP decreased from 1242.0 ng/l [582.0–4019.5] to 779.0 ng/l [373.3–2676.8], p&lt;0,001). Left ventricular ejection fraction statistically significant improved (26.53 (±11.63) % v.s. 31.19 (±11.45) %, (p&lt;0.0001). QoL statistically significant improved (58.30±20.92 vs 37.92±22.53) (p&lt;0.0001). Patients after training have improved their physical and psychological status (p&lt;0.0001). QoL assessment is related to the left ventricular ejection fraction r=−0.229, p&lt;0.05 and to NT pro BNP r=−0.3, p&lt;0.05.

Conclusions
Participating in the long-term training and monitoring program following hospital discharge improves HF patient's QoL with a positive impact on NT-pro BNP marker value and LVEF.

Funding Acknowledgement
Type of funding sources: None.