Tsuyuki Ross T, Lockwood Evan E, Shibata Marcelo C, Simpson Scot H, Tweden Kari L, Gutierrez Rosa, Reddy Maria C, Rowe Brian H, Villa-Roel Cristina, Fradette Miriam
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
CJC Open. 2019 Jan 17;1(2):62-68. doi: 10.1016/j.cjco.2018.12.001. eCollection 2019 Mar.
Heart failure (HF) exacerbations often relate to poor self-care. Education programs improve outcomes, but are resource-intensive. We developed a video-based educational intervention and evaluated it in patients with HF.
Congestive Heart Failure utreach rogram of ducation was a pragmatic multicenter randomized trial. We included subjects with HF if they were hospitalized, seen in the emergency department (ED), or high-risk outpatients, and randomized them to intervention or control. Intervention included a 20-minute video, supplementary booklet, and 3 bimonthly newsletters focusing on salt and fluid restriction, daily weights, and medications. Subjects watched the video and were encouraged to review it at home, along with the booklet/newsletters. Control subjects received the booklet only. The primary outcome was the difference in cardiovascular hospitalizations or ED visits between groups at 6 months. Secondary outcomes included clinical events and in-hospital days.
We recruited 539 subjects from 22 centers in Canada and the United States. Baseline characteristics were similar in both groups: 64% were male and had a mean age of 66 (± 13) years, mean ejection fraction 31% (± 13.5), and 65% New York Heart Association Functional Classification III/IV. The primary outcome occurred in 57 subjects (21%) in the intervention group compared with 61 subjects (23%) in the control group ( = 0.66). There were no significant differences in prespecified secondary outcomes; however, death occurred in 18 subjects (7%) in the intervention group and 33 subjects (12%) in the control group ( = 0.03).
Video education on self-care did not reduce hospitalizations or ED visits in patients with HF. Of note, mortality was lower in the intervention group.
心力衰竭（HF）急性加重通常与自我护理不佳有关。教育项目可改善预后，但资源消耗大。我们开发了一种基于视频的教育干预措施，并在HF患者中进行了评估。
充血性心力衰竭教育外展项目是一项实用的多中心随机试验。我们纳入了因住院、在急诊科就诊或为高危门诊患者的HF患者，并将他们随机分为干预组或对照组。干预措施包括一段20分钟的视频、补充手册以及3份每两个月一期的时事通讯，内容聚焦于限盐限水、每日称重和药物治疗。受试者观看视频，并被鼓励在家中与手册/时事通讯一起复习。对照组受试者仅收到手册。主要结局是6个月时两组之间心血管住院或急诊科就诊的差异。次要结局包括临床事件和住院天数。
我们从加拿大和美国的22个中心招募了539名受试者。两组的基线特征相似：64%为男性，平均年龄66（±13）岁，平均射血分数31%（±13.5），65%为纽约心脏协会心功能分级III/IV级。干预组有57名受试者（21%）出现主要结局，而对照组有61名受试者（23%）出现主要结局（P = 0.66）。预设的次要结局没有显著差异；然而，干预组有18名受试者（7%）死亡，对照组有33名受试者（12%）死亡（P = 0.03）。
自我护理的视频教育并未减少HF患者的住院或急诊科就诊次数。值得注意的是，干预组的死亡率较低。
