Following Self-Management Instructions Pays Off for Patients Hospitalized with Heart Failure

MURRAY, UT (9/14/2010) – Providing standardized education to heart failure patients upon their discharge from the hospital translates into meaningful improvements in patient survival, according to a new study by cardiac researchers from the Heart Failure and Treatment Program at the Heart Institute at Intermountain Medical Center.

While widespread evidence shows that heart failure medications and devices can improve survival, results from the new study show that providing patient education is just as important to patient care and can result in significantly improved survival and lower healthcare costs, especially since heart failure is the only major cardiovascular disorder on the rise.

Results of the study were presented this week at the Heart Failure Society of America's annual scientific session in San Diego, CA.

Intermountain Medical Center researchers tracked more than 1,500 patients who were given specific discharge instructions about self-management using an educational program developed specifically for heart failure patients at Intermountain Healthcare. The MAWDS program (which stands for Medications, Activity, Weight, Diet and Symptoms) teaches patients the importance of taking and understanding their medications, staying physically active, tracking weight fluctuations on a daily basis, limiting sodium intake in their diet and monitoring for changes in their symptoms.

Patients who received documented MAWDS education while in the hospital between June 2002 and June 2004 had better one-year survival rates (84.1% vs. 81%) than those without documented discharge instructions, and better three-year survival rates (65.8% vs. 60.2%.) Even after controlling for age, gender, diagnosis, length of hospital stay, and severity of illness, results showed that the five-year survival rate for those who received discharge education was higher (57.1%) than for those without discharge education (49.6%).

“We developed and have implemented this MAWDS program across Intermountain Healthcare,” says Kismet Rasmusson, FNP-BC, FAHA, a heart failure nurse practitioner and lead researcher of the study. “This data speaks to the importance of having a standardized, consistent educational message. We educate nurses at all of our hospitals to make sure they understand the necessity of this education. It’s our nurses who educate patients and foster their understanding of how to live with heart failure once they are discharged from the hospital.”

Heart failure is common, but unrecognized and often misdiagnosed. It affects nearly five million Americans. Heart failure is the only major cardiovascular disorder on the rise. An estimated 400,000 to 700,000 new cases of heart failure are diagnosed each year and the number of deaths in the United States from this condition has more than doubled since 1979, averaging 250,000 annually.

What she and her colleagues hope is that by providing standardized MAWDS education, heart failure patients will better follow self-management strategies when they go home; that they will know what to do, who to call, and when to call if they have problems or questions.

Limiting symptoms and maintaining quality of life with heart failure is a balancing act. The MAWDS program includes a self-care diary to help patients and family members track their daily progress. Managing sodium and fluid intake, along with taking numerous heart failure medications, can be a big challenge. Most patients are restricted to two grams of sodium per day. (The average American consumes 5-9 grams per day.) Sodium is one of the biggest factors in water retention – or congestion - a condition that dramatically increases symptoms of shortness of breath in heart failure patients.

Rasmusson says tracking their medication, activity, weight, diet and symptoms helps heart failure patients and their providers better maintain that healthy balance.

“We hope their understanding of this disease is enhanced through education,” she says. “We further hope to enhance their ability to comply with a complex treatment plan and to enhance their ability to self-monitor, by helping them set goals to improve quality of life, improve their symptoms, and improve survival.”

Learn more about Intermountain's Heart Failure Program