Abstract as Presented at the Canadian Cardiovascular Congress October 2011 (Updated October 19, 2011)
Congestive Heart Failure Outreach Program of Education (COPE): a Randomized, Controlled Study
R.T. Tsuyuki, E.E. Lockwood, M.C. Shibata, S. Simpson, K.L. Olson, R. Gutierrez, M.C. Reddy, M Fradette
Background
Acute precipitants of heart failure (HF) often relate to poor self-care and knowledge about the condition. Intensive education and support programs are associated with improved outcomes but are very resource intensive. We developed a practical, video-based educational program and evaluated its impact on clinical events.
Methods:
Design: Randomized controlled trial.
Subjects: Patients with HF were approached for inclusion if they were hospitalized, seen in the emergency department (ED) or in an outpatient clinic (the latter with a HF hospitalization in the past 6 months).
Intervention: The COPE educational program consisted of a 20 minute video, supplementary booklet and 3 bimonthly newsletters focusing on 3 previously identified key areas of knowledge deficiency: salt and fluid restriction, daily weights and medications. Patients randomized to the intervention group watched the video at least once and were encouraged to review it at home, along with the booklet/newsletters and discuss questions with their physicians.
Usual Care: These patients received the booklet only and were encouraged to speak with their physicians.
Follow-up: All patients were contacted by telephone at 6 months to determine clinical events (hospitalizations and ED visits).
Outcomes: The primary outcome was the difference in cardiovascular (CV) events (hospitalizations or ED visits) between groups. Secondary outcomes included all-cause and HF-related hospitalizations, and in-hospital days.
Results
A total of 539 patients were recruited from 22 centres in Canada and the US. Baseline characteristics were similar in both groups: 64% males, mean age 66 (± 13) years, mean ejection fraction 31% (± 13.5), 65% NYHA III/IV, 44% had ischemic etiology, 38% were newly diagnosed with HF and 35% had HF for less than 1 year, 77% had high school/post secondary education and 36% resided at home with support.
| Outcome | Intervention n=270 n(%) |
Usual Care n=269 n(%) |
P |
|---|---|---|---|
| CV hospitalization or ED visit | 57 (21) | 61 (23) | 0.66 |
| HF related hospitalization | 22 (8) | 22 (8) | 0.99 |
| All-cause hospitalization | 50 (19) | 56 (21) | 0.50 |
| All-cause hospital days, median, (interquartile range) | 12 (4.25) | 10.5 (4.5,20) | 0.80 |
| Death, n (%) | 18 (7) | 33 (12) | 0.03 |
| CV hospitalization or death | 53 (20) | 71 (26) | 0.06 |
Conclusion
Among this high-risk HF population, education about self care behaviours did not improve clinical outcomes. Perhaps the “dose” of our intervention was too low or that the knowledge and behavioural change paradigm interaction requires further study. Mortality was lower in the intervention group, although the numbers were small.
Patient Resources
COPE-PAKSAC patient knowledge survey
Video: Success with Heart Failure: 3 Key Steps
Booklet: Success with Heart Failure: 3 Key Steps
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