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.
DeWalt
Darren A
DA
Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. dewaltd@med.unc.edu
Malone
Robert M
RM
Bryant
Mary E
ME
Kosnar
Margaret C
MC
Corr
Kelly E
KE
Rothman
Russell L
RL
Sueta
Carla A
CA
Pignone
Michael P
MP
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