Effectiveness of a patient education programme in heart failure with preserved ejection fraction: Results from the ODIN cohort study using propensity score matching
Nelly Agrinier, Matthieu Schockmel, Nathalie Thilly, Hervé Laborde-Castérot, Patrick Jourdain, François Alla, Christophe Leclercq, François Dany, Justine Druelle, Emilie Drouet, Geneviève Mulak, Yves Juillière, ODIN cohort participants, Nelly Agrinier, Matthieu Schockmel, Nathalie Thilly, Hervé Laborde-Castérot, Patrick Jourdain, François Alla, Christophe Leclercq, François Dany, Justine Druelle, Emilie Drouet, Geneviève Mulak, Yves Juillière, ODIN cohort participants
Abstract
Background: Patient education programmes (PEP) are recommended for patients with heart failure but have not been specifically assessed in heart failure with preserved ejection fraction (HFpEF).
Aim: To assess the effectiveness of a structured PEP in reducing all-cause mortality in patients with HFpEF.
Methods: Patients with HFpEF were selected from the ODIN cohort, designed to assess PEP effectiveness in patients with HF whatever their ejection fraction, included from 2007 to 2010, and followed up until 2013. Baseline sociodemographic, clinical, biological and therapeutic characteristics were collected. At inclusion, patients were invited to participate in the PEP, which consisted of educational diagnosis, education sessions and final evaluation. Education focused on HF pathophysiology and medication, symptoms of worsening HF, dietary recommendations and management of exercise. Propensity score matching and Cox models were performed.
Results: Of 849 patients with HFpEF, 572 (67.4%) participated in the PEP and 277 (32.6%) did not. Patients who participated in the PEP were younger (67.0±13.1 vs 76.1±13.2 years; standardized difference [StDiff] =-54.6%), less often women (39.7% vs 48.4%; StDiff =-17.6%) and presented more often with hypercholesterolaemia (55.2% vs 35.2%; StDiff 41.2%), smoking (35.1% vs 28.7%; StDiff 13.8%), alcohol abuse (14.1% vs 8.9%; StDiff 16.5%) and ischaemic HF (38.7% vs 29.2%; StDiff 20.0%) than those who did not; they also presented with better clinical cardiovascular variables. After propensity score matching, baseline characteristics were balanced, except hypertension (postmatch StDiff 19.1%). The PEP was associated with lower all-cause mortality (pooled hazard ratio 0.70, 95% confidence interval 0.49-0.99; P=0.042). This association remained significant after adjustment for hypertension (adjusted pooled hazard ratio 0.68, 95% confidence interval 0.48-0.97; P=0.036).
Conclusions: In this investigation, a structured PEP was associated with lower all-cause mortality. Patient education might be considered an effective treatment in patients with HFpEF.
Keywords: Cohort; Cohorte; Diastolic; Heart failure; Insuffisance cardiaque; Mortality; Mortalité; Patient education; Propensity score; Score de propension; Éducation thérapeutique du patient.
Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Source: PubMed