title: Educational attainment has a limited impact on disease management outcomes in heart failure.
abstract: The objective of this study was to assess whether educational attainment moderates outcomes in the intervention group in a trial of disease management in heart failure (HF). Data were collected from a sample of 654 patients enrolled in the disease management arm of a community- based study of HF patients. The full sample was used to analyze two primary outcomes- all-cause mortality and cardiac event-free survival. Two other primary outcomes- rates of HF-related emergency department (ED) visits and inpatient admissions-and secondary outcomes (patient self-confidence in managing HF symptoms and daily dietary sodium intake in milligrams) were analyzed in a smaller sample of 602 patients who completed at least 6 months of disease management. One-way analysis of variance and chi (2) tests were used to assess differences in baseline demographic and clinical characteristics. Survival analyses were conducted with proportional hazards regression, while negative binomial regression was used to assess educational differences in ED usage and inpatient admissions. Repeated measures analysis of variance models were used to assess whether secondary outcomes differed across educational strata and/or over time. All outcome analyses were adjusted for confounders. Patients with the least education fared the poorest for all-cause mortality, but education- related differences failed to achieve statistical significance. No education-related differences were observed for cardiac event-free survival, or for the rates of inpatient admission and ED usage. For secondary outcomes, sodium intake differed significantly by education (p = 0.04), with the largest drop (-838 mg/day) observed in the least well-educated group. Confidence increased an approximately equal amount (2.1-3.0 points on a 100-point scale) across all educational strata (p = ns). Low educational attainment may not be a barrier to effective disease management.
authors.affiliation: Altarum Institute, San Antonio, Texas., Disease Management Center, University of Texas Health Science Center, San Antonio, Texas 78209, USA. brad.smith@altarum.org
authors.forename: Brad
authors.initials: B
authors.lastname: Smith
authors.forename: Emma
authors.initials: E
authors.lastname: Forkner
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
authors.forename: Autumn Dawn
authors.initials: AD
authors.lastname: Galbreath
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Freeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D018572:Disease-Free Survival; D004522:Educational Status; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013781:Texas; D016896:Treatment Outcome