title: Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure.
abstract: BACKGROUND
  Patients with heart failure (HF) face challenges complying with multidrug regimens.
  
  
  OBJECTIVE
  To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF.
  
  
  METHODS
  Patients were randomized to either usual care or an inhospital educational intervention delivered by a multidisciplinary team (Intervention).
  
  
  METHODS
  Acute medical and surgical units at a teaching hospital.
  
  
  METHODS
  One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of < 40% requiring long-term medical treatment.
  
  
  METHODS
  A validated HF-specific instrument provided a measure of knowledge. We characterized patients as noncompliant if pharmacy refill data suggested they had taken < or = 0.80 of their medication. We measured quality of life using the Minnesota Living with Heart Failure Questionnaire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality, readmissions, and emergency department visits.
  
  
  RESULTS
  The Intervention group showed higher knowledge scores at discharge and 1 year (P = .05). The risk of noncompliance in Intervention patients varied from 0.78 (95% CI 0.33-1.89) for ACE-I (13% Intervention, 17% Control) to 1.02 (0.49-2.12) for diuretics (23% Intervention, 23% Control). Quality of life improved in both groups over time; the only difference between groups favored the Intervention (Minnesota Living with Heart Failure Questionnaire, P = .04). The composite end point occurred in 67% of control and 60% of Intervention patients (hazard ratio 0.85, 95% CI 0.55-1.30).
  
  
  CONCLUSIONS
  An inhospital educational intervention improved knowledge and, possibly, quality of life and may be useful as part of a comprehensive compliance enhancing strategy in patients with HF.
authors.affiliation: Division of Critical Care, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Femida H
authors.initials: FH
authors.lastname: Gwadry-Sridhar
authors.forename: J Malcolm O
authors.initials: JM
authors.lastname: Arnold
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: James E
authors.initials: JE
authors.lastname: Brown
authors.forename: Gordon
authors.initials: G
authors.lastname: Marchiori
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010349:Patient Compliance; D010353:Patient Education as Topic; D010865:Pilot Projects; D011788:Quality of Life