P003. An Evidence Based Quality Improvement Project of the Impact of a Nurse Practitioner Led Heart Failure, Self-Care Focused, Patient Education on Healthcare Related Quality of Life

Background Heart failure (HF) is a progressive and debilitating disease with high morbidity and mortality rates. HF affects both physical and psychosocial health with over 75% of HF patients experiencing frailty and 10-40% of HF patients having difficulty preforming activities of daily living. These limitations heavily impact healthcare related quality of life (HRQOL). Patient education has been shown to improve HF outcomes, but it remains poorly utilized. Objective This evidence-based quality improvement project aims to show that a HF education packet with nurse practitioner (NP) led reinforcement can improve HRQOL. Methods This project uses a comparison prospective design that assesses pre and post intervention scores on the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Participants had chronic heart failure and were selected from HF clinic referrals. A HF packet with educational materials focused on self-care education with reinforcement provided by NPs in the HF clinic was given to participants. Data on demographics, comorbidities, time since onset of HF, quantity of follow ups, and time between initial and post visit was collected. A KCCQ-12 was given at their initial visit and at a 3-6 month post initial visit. Results 12 participants were enrolled. KCCQ-12 domains and HRQOL metrics, including physical limitation (MD = 21.92, SD = 32.4, p = .039), quality of life (QOL) (MD = 20, SD = 26.8, p = .025), and overall summary score (MD = 14.67, SD = 18.2, p = .018). had a statistically significant improvement. Social limitations (MD = 8.08, SD = 31.1, p = NS) and symptom frequency (MD = 8.25, SD = 14.8, p = NS) had a trend towards improvement, but did not reach statistical significance. Within the reduced HF subgroup (N = 9) physical limitations (MD = 27.67, SD = 35.1, p = .038) and overall summary score (MD = 17.89, SD = 20.1, p = .028) significantly improved. Uniquely, symptom frequency (MD = 12.11, SD = 11.1, p = .011) significantly improved in the reduced HF subgroup. There was no statistically significant improvement in the preserved HF subgroup (N = 3) in any of the KCCQ-12 domains. There were no HF hospitalizations during the 3-6 month follow-up. Conclusion This project shows that a guideline driven patient education intervention that focuses on self-care via a HF packet with NP follow up to reinforce education improved overall HF HRQOL. Improvement in the KCCQ-12 overall summary score indicates improved HF outcomes such as reduced HF hospitalizations and mortality. Creating a standardized HF education packet that is readily available and can guide patients and clinicians in their HF education discussion may increase rate of HF patient education in clinics, although this study did not measure this specifically. Further studies, with larger participant base, are needed to confirm efficacy of this type of intervention in patients with HF with preserved ejection fraction. In addition, Studies with longer duration would be beneficial to assess impact on mortality.