title: How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study.
abstract: BACKGROUND
  Although the effectiveness of heart failure (HF) disease management programs has been established in Western countries, to date there have been no such programs in Japan. These programs may have different effectiveness due to differences in health care organization and possible cultural differences with regard to self-care. Therefore, the purpose of this study was to evaluate the effectiveness of a pilot HF program in a Japanese setting.
  
  
  METHODS
  We developed an HF program focused on enhancing patient self-care before hospital discharge. Patients were randomized 1:1 to receive the new HF program or usual care. The primary outcome was self-care behavior as assessed by the European Heart Failure Self-Care Behavior Scale (EHFScBS). Secondary outcomes included HF knowledge and the 2-year rate of HF hospitalization and/or cardiac death.
  
  
  RESULTS
  A total of 32 patients were enrolled (mean age, 63 years; 31% female). There was no difference in the total score of the EHFScBS between the two groups. One specific behavior score regarding a low-salt diet significantly improved compared with baseline in the intervention group. HF knowledge in the intervention group tended to improve more over 6 months than in the control group (a group-by-time effect, F=2.47, P=0.098). During a 2-year follow-up, the HF program was related to better outcomes regarding HF hospitalization and/or cardiac death (14% vs 48%, log-rank test P=0.04). In Cox regression analysis after adjustment for age, sex, and logarithmic of B-type natriuretic peptide, the program was associated with a reduction in HF hospitalization and/or cardiac death (hazard ratio, 0.17; 95% confidence interval, 0.03-0.90; P=0.04).
  
  
  CONCLUSIONS
  The HF program was likely to increase patients' HF knowledge, change their behavior regarding a low-salt diet, and reduce HF hospitalization and/or cardiac events. Further improvement focused on the transition of knowledge to self-care behavior is necessary.
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden; JSPS Postdoctoral Fellow for Research Abroad, Tokyo, Japan.
authors.forename: Naoko P
authors.initials: NP
authors.lastname: Kato
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.affiliation: Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Sano
authors.affiliation: Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Asuka
authors.initials: A
authors.lastname: Kogure
authors.affiliation: Department of Pharmacy, The University of Tokyo Hospital, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Fumika
authors.initials: F
authors.lastname: Sakuragi
authors.affiliation: Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kihoko
authors.initials: K
authors.lastname: Kobukata
authors.affiliation: Department of Clinical Data Management, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtsu
authors.affiliation: Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Wakita
authors.affiliation: Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Adult Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Kazuma
keywords: discharge education; disease management; hospitalization; knowledge; nursing; patient education