title: Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting.
abstract: BACKGROUND
  Heart failure (HF) patients living in rural areas have a lack of HF knowledge and poor self-care because of limited medical care access. Multidisciplinary education to improve self-care behavior is indispensable for such patients. The present study evaluated whether intensive inpatient education improved outcomes of hospitalized HF patients in a Japanese rural setting.
  
  
  METHODS
  An inpatient HF management program based on multidisciplinary team intervention was applied to hospitalized HF patients in a Japanese rural area. We defined patients treated within the program from May 2009 to April 2011 as the intervention group (n = 144), and those treated with the usual care from May 2006 to April 2009 as the usual care group (n = 133). The composite endpoints of HF hospitalization and all-cause mortality were compared between the two groups.
  
  
  RESULTS
  Compared with patients in the usual care group, those in the intervention group more often received the optimal interventions such as discharge use of β-blockers, cardiac rehabilitation, pre-discharge diagnostic tests, and multidisciplinary intensive education including nurse-led patient education, pharmacist's medication teaching, and dietitian's nutritional guidance (all P < 0.05). The incidence of the composite endpoints significantly decreased after introducing the program (P < 0.001). Among a number of interventions, multidisciplinary intensive education was the most effective intervention to improve the primary outcome (P < 0.001).
  
  
  CONCLUSIONS
  Multidisciplinary intensive education is a key strategy for helping improve the outcome for Japanese HF patients in a rural setting. Our data may give a positive impact on the improvement of healthcare system in Japan.
authors.affiliation: Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan. ykinugasa-circ@umin.ac.jp.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kinugasa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kato
authors.forename: Shinobu
authors.initials: S
authors.lastname: Sugihara
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Kensaku
authors.initials: K
authors.lastname: Yamada
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hirai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation*; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010353:Patient Education as Topic; D012189:Retrospective Studies; D019035:Rural Health Services; D012648:Self Care