Intermountain Press Release

Salt Lake City—LDS Hospital clinicians have demonstrated that the patient self-management educational tools and community educational forums they developed for patients diagnosed with heart failure significantly improves those patient's chances for survival after they leave the hospital, according to a major new study by researchers at the hospital.

Findings of the study were reported Thursday, April 7, 2005, at the 25th scientific session of the International Society for Heart and Lung Transplantation in Philadelphia.

Nearly a million patients per year nationwide are hospitalized with congestive heart failure (CHF) as their primary or secondary diagnosis. Though they are subsequently discharged, 20 percent are readmitted within a month and nearly 50 percent are readmitted within six months. Some don't survive to be re-admitted, according to Jill A. Hall, MS, FNP, a Nurse Practitioner for the Heart Failure Prevention and Treatment Program at LDS Hospital and principal investigator of the study.

Many of these reoccurrences are preventable, however, because they result from patients' misunderstanding or failing to comply with their doctor's instructions regarding diet and medications. A prime factor in this lack of compliance has been a lack of a standardized patient educational tools for heart failure patients, according to Hall.

Since 2002, LDS Hospital clinicians have been working to change that and the work is now paying off for patients. Beginning in 2002, LDS Hospital clinicians developed a simple, standardized set of self-management instructions, and training procedures to be introduced to heart failure patients at LDS Hospital and throughout the entire Intermountain Health Care (IHC) hospital system. The self-management instructions are referred to as MAWDS, an acronym taken from Medication, Activity, Weight, Diet, and Symptoms, which are the topics identified as most vital for patient instruction and self-monitoring.

"To implement MAWDS it was first necessary to train nurses and doctors about the educational materials and forums available. Then, through one-on-one instruction, trained nurses and doctors in turn began instructing patients and/or their home-care givers. This instruction covered all five areas of MAWDS: compliance with medication regimens; performing daily physical activity; documenting daily weight measurements (a sudden gain in weight due to fluid retention is characteristic of CHF); dietary restrictions; and careful self-monitoring of symptoms. Emphasis was given to instructing patients in exactly what to do if any of their symptoms worsened. Also of importance was that instructors documented and verified each patient's training on standardized forms," says Hall.

Currently, 80 percent of all heart failure patients discharged from LDS Hospital and throughout the IHC system are receiving MAWDS training and the positive results have been evident from the beginning.

"From the time we first began MAWDS education with a few patients, it became obvious that the rates of readmission for the MAWDS-trained patients was dropping relative to those who had not received training," said Hall. "As implementation of MAWDS training has progressed, the difference has become dramatic. More importantly, survival rates have also increased dramatically for trained-patients as well. This is very exciting," Hall says. "As time goes on we'll be watching to see if these results apply to long term survival rates as well."

Other LDS Hospital clinicians involved in this work were, Kismet Rasmusson, MS, FNP; Holly Rimmasch, MS; C. A. Roberts, MS; T.K. French, MStat; A.G. Kfoury, MD; Linda Hofmann, MS; and Dale Renlund, MD.