If you have ever been in the hospital for a heart condition, it is likely that before discharge, someone will come around, give you a book on heart disease and tell you to modify your life in order to live longer. In most cases, there is never any attempt to follow up with you after discharge. The hospital staff likely refers to this process as patient education, but unless they actually spend time to teach you the skills you need to perform, as well as observe your performance, education reverts back to your either reading the book or, as is often the case, discarding it where it will never be read. Fortunately, there are facilities where they add elements of self-management to help you deal more effectively with heart failure.

A study by Wright and colleagues in New Zealand looked at whether patient education and self-management strategies, such as daily recording of body weight and use of a patient diary, decrease hospital readmissions and improve quality of life. They were particularly interested in the role of individual components of these programs and their contribution to patient benefit. Patients with heart failure were randomized into a management or usual care groups. Those in the management group were given a heart failure diary for the recording of daily weights, attended a heart failure clinic, and were encouraged to attend three education sessions. Patients in the usual care group received routine clinical care, mainly from general practitioners. All participants were followed to 12 months. The study investigated self-management components by looking at diary use and self-weighing behavior in the group receiving the heart failure intervention, and compared the level of knowledge of heart failure self-management of the management group to the control group after 12 months.

Of the 197 patients in the study, 100 patients were included in the management group and received a diary and education about heart failure self-management including monitoring weight daily. Of these patients, 76 patients used the diary. These patients were on more medication; and were more likely to attend the education sessions, the heart failure clinic, used primary care, and had a lower mortality rate over the course of the study. Variables independently associated with use of the diary included less severe symptoms, frequent attendance at the heart failure clinic, and attendance at an education session. Of the 76 patients who used the diary, 51 weighed themselves regularly. More of these patients owned scales at home; they were also more likely to attend the education sessions, and experienced fewer hospital admissions than those patients who did not weigh themselves regularly. Variables independently associated with regular self-weighing included the presence of scales at home and attendance at the education session(s). Patients in the management group exhibited higher levels of knowledge at 12 months of follow-up, and were more likely to monitor their condition using daily weighing compared to the control group.

COMMENTS: The authors concluded that at 12 months of follow-up, use of self-management skills including daily weight monitoring and level of education on self-management was significantly higher in the management group than the control group. This outcome would be expected as self-monitoring is the backbone of self-management. In fact, self-monitoring by itself can lead to behavior change. For example, many of us lose weight by regularly monitoring our weight. This approach does not work for everyone; regular weighing may, in fact, produce negative behaviors when there is failure to see weight loss. Nevertheless, as demonstrated here, the combination of education and self-monitoring was effective when used in a heart failure management program. The moral here is not to give up on your bathroom scales when dieting!

Do you have any comments?

S.P. Wright et al. Uptake of self-management strategies in a heart failure management programme. European Journal of Heart Failure, 2003;5:371-380.