Self-care counseling no help to heart patients

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Group meetings to help people with heart failure take better care of themselves don’t cut death rates any more than health tips in the mail, U.S. researchers said Tuesday.

The authors had hoped that teaching patients how to better manage their condition—in which the heart fails to pump out enough blood—would also improve it.

And there is room for improvement: As many as two-thirds of hospital admissions for heart failure are thought to be caused by patients not following recommended drug treatments and lifestyle advice, such as cutting back on salt and exercising more. 

The condition affects some five million Americans and is involved in about 300,000 deaths a year, according to the National Institutes of Health.

What the new results don’t mean, said Dr. James E. Calvin of Rush University Medical Center in Chicago, is that taking charge of your own disease is useless.

“People really do need to understand their disease, they need to understand their medications and how to take them properly,” said Calvin, who worked on the new study. “A physician prescribing medications and giving advice about reducing salt in the diet, I don’t think that’s cutting it.”

So he and his colleagues tested if self-management skills—such as relying more on friends and family, or leaving drugs on the kitchen counter as a reminder to take them when preparing breakfast—would make a difference.

Past studies haven’t backed the idea, but they have been short-lasting and small. This time, more than 900 patients participated and were followed for two to three years.

Half of the patients were randomly assigned to two-hour meetings taking place frequently over one year, in which they learned about their condition and self-management skills to manage it.

The other half received the same health tips in the mail (from the American Heart Association, available at http://www.hearthub.org/hc-heart-failure.htm), including phone calls to make sure they understood the material. But they weren’t taught self-management skills.

Blood pressure medications such as beta blockers and ACE inhibitors can improve both the fluid buildup and tiredness that often accompany heart failure, and they help patients live longer, too.

In the course of the study, 163 deaths or hospitalizations due to heart failure (40 percent) occurred in the self-management group; the number was very similar in the education-only group (171, or 41 percent).

“The skill teaching that was done was not overly beneficial,” Calvin told Reuters Health, adding that there might have been a small benefit to low-income patients.

So why didn’t the self-management techniques work?

“One explanation for the neutral result might be that the control group received telephone calls to ensure that they had understood the information they were sent,” according to an editorial in the journal.

Trifling as it may seem, that bit of interaction with health providers may be more than many patients get outside of clinical studies.

“So many different types of people care for heart failure patients, ranging from general practitioners in rural areas and small towns to private practice cardiologists not connected to an academic medical center to the large academic medical hospitals,” longtime medical writer Mary Knudson, who teaches at Johns Hopkins University in Baltimore, told Reuters health in an e-mail.

“So I’m sure it varies quite a bit how much any caregiver keeps in touch with patients.”

Knudson, a heart failure survivor and co-author of Living Well with Heart Failure: The Misnamed, Misunderstood Condition (Johns Hopkins University Press, 2010), said getting the right care often requires the patient to take control.

“Patient understanding of heart failure and knowledge of best treatments and faithfully following those treatments is key to success with heart failure,” she said.

“It certainly was for me. I found the national treatment guidelines through my own research and saw that my first three cardiologists had not put me on two of the basic medicines for heart failure proven to treat it and extend life—an ACE inhibitor and a beta blocker.”

After she got on the right treatment, her heart stopped needing to struggle to pump out blood. “I am told I no longer have heart failure,” she said.

Calvin, a cardiologist, agreed his profession should do a better job of following treatment guidelines. He noted only a third of doctors currently do so.

“The doctors fail as well the patients,” he said. “If you are a patient and your doctor isn’t telling you about your drugs and your diet, you should go further.”

SOURCE:  JAMA/Journal of the American Medical Association, September 22, 2010.

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