A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170].
BACKGROUND
Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care.


METHODS
We performed a 12-month randomized controlled trial. From November 2001 to April 2003, we enrolled participants aged 30-80, who had heart failure and took furosemide. Intervention patients received education on self-care emphasizing daily weight measurement, diuretic dose self-adjustment, and symptom recognition and response. Picture-based educational materials, a digital scale, and scheduled telephone follow-up were provided to reinforce adherence. Control patients received a generic heart failure brochure and usual care. Primary outcomes were combined hospitalization or death, and heart failure-related quality of life.


RESULTS
123 patients (64 control, 59 intervention) participated; 41% had inadequate literacy. Patients in the intervention group had a lower rate of hospitalization or death (crude incidence rate ratio (IRR) = 0.69; CI 0.4, 1.2; adjusted IRR = 0.53; CI 0.32, 0.89). This difference was larger for patients with low literacy (IRR = 0.39; CI 0.16, 0.91) than for higher literacy (IRR = 0.56; CI 0.3, 1.04), but the interaction was not statistically significant. At 12 months, more patients in the intervention group reported monitoring weights daily (79% vs. 29%, p < 0.0001). After adjusting for baseline demographic and treatment differences, we found no difference in heart failure-related quality of life at 12 months (difference = -2; CI -5, +9).


CONCLUSIONS
A primary care-based heart failure self-management program designed for patients with low literacy reduces the risk of hospitalizations or death.
Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. dewaltd@med.unc.edu
Darren A
DA
DeWalt
Robert M
RM
Malone
Mary E
ME
Bryant
Margaret C
MC
Kosnar
Kelly E
KE
Corr
Russell L
RL
Rothman
Carla A
CA
Sueta
Michael P
MP
Pignone
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D019468:Disease Management; D004232:Diuretics / Q000008:administration & dosage; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000401:mortality / Q000517:prevention & control*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000379:methods*; D016730:Program Development; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care
D004232:Diuretics