Use of nonpharmacologic treatment approaches in patients with heart failure

BACKGROUND: Patient education has been shown to beneficially impact the utilization of medical resources and certain outcomes in patients hospitalized with heart failure (HF). Little data are, however, available about the implementation of patient education and counseling of patients with HF in the community setting. The purpose of the present investigation was to examine the extent of health care provider recommendations for the monitoring or modification of lifestyle approaches or dietary factors in patients with new onset HF discharged from all greater Worcester (MA) hospitals in 2000. METHODS: The study sample consisted of 2411 metropolitan Worcester residents hospitalized at all 11 area medical centers with acute HF. Based on the review of medical records, we examined provider recommendations for the monitoring or modification of 5 lifestyle factors including salt restriction, dietary changes, increased physical activity, limitation of fluids, and daily monitoring of weight in hospital survivors of HF. RESULTS: Among all patients, approximately 22% were recommended to change either no or 1 lifestyle related factor, 2 in every 5 patients received recommendations to alter any 2 lifestyle characteristics, while 1 in 6 were counseled about the importance of monitoring or modifying 4 or more lifestyle or dietary factors. Physician counseling was associated with several demographic and clinical factors. Documentation of none or few patient education recommendations was also associated with the failure to receive multiple effective medical therapies for HF. CONCLUSIONS: The results of our community-wide investigation suggest that considerable opportunity remains for the more effective hospital counseling of patients with acute HF.