title: Therapeutic patient education and all-cause mortality in patients with chronic heart failure: a propensity analysis.
abstract: BACKGROUND
  Meta-analyses of disease management programs have shown favorable effects in chronic heart failure. Therapeutic patient education forms an integral part of these programs and may influence mortality per se. We aimed to determine the relationship between therapeutic patient education applied in routine clinical practice and long-term mortality in chronic heart failure.
  
  
  METHODS
  From 2007 to 2010 (median follow-up: 27.2 months), heart failure patients were prospectively enrolled in a multicenter, 'real-world', French cohort by centers previously trained in therapeutic patient education. As educated and non-educated patient profiles were expected to differ, mortality was assessed using conventional multivariate analyses and analyses made on propensity-matched cohorts for the application of therapeutic patient education.
  
  
  RESULTS
  Of the 3237 patients who participated in the study (67.5 years; 69.5% men), 2347 were educated (72.5%) and 890 were not educated (27.5%). Non-educated patients were older, more often female, and more severely diseased than educated patients. All-cause mortality was 17.3% in the educated group vs. 31.0% in the non-educated group (adjusted HR 0.70, 95% CI 0.58-0.84, P<.001). This association remained in paired groups after adjustment for all baseline covariates excluding (model 1) or including (model 2) cardiovascular medications and propensity score (HR 0.72, 95% CI 0.58-0.90, P=.003; HR 0.73, 95% CI 0.59-0.90, P=.004, respectively).
  
  
  CONCLUSIONS
  In chronic heart failure, therapeutic patient education by trained healthcare professionals appears associated with lower all-cause mortality. These data may have important implications in terms of healthcare organization, because they suggest that therapeutic patient education should be developed in all types of cardiology centers.
authors.affiliation: Cardiology, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Nancy, France. y.juilliere@chu-nancy.fr
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.forename: Patrick
authors.initials: P
authors.lastname: Jourdain
authors.forename: Christine
authors.initials: C
authors.lastname: Suty-Selton
authors.forename: Thierry
authors.initials: T
authors.lastname: Béard
authors.forename: Véronique
authors.initials: V
authors.lastname: Berder
authors.forename: Brigitte
authors.initials: B
authors.lastname: Maître
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Trochu
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.forename: Benoît
authors.initials: B
authors.lastname: Pace
authors.forename: Geneviève
authors.initials: G
authors.lastname: Mulak
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010353:Patient Education as Topic / Q000379:methods*; D057216:Propensity Score; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult