Q: Our agency continues to have a high rehospitalization rate for heart failure patients. What can we do to address this?

According to the American Heart Association (2018), 5.7 million Americans have heart failure. To prevent hospitalizations, patients with heart failure must understand this chronic disease and know how to manage it to achieve a better quality of life. As a certified heart failure nurse with a focus on caring for patients in the community, I developed a class to teach high-risk patients with heart failure in the offices of their primary care physician (PCP). The goal was to target disease process, early symptoms to report to their physician, and self-management skills.

The first step was to send an invitation to four PCP offices offering a free heart failure education program for their patients. The program consisted of four 1-hour weekly classes. The PCPs chose a maximum of 10 participants and sent them letters explaining the heart failure education program and invited them to enroll. Once the participants were identified, I called to introduce myself and confirm their enrollment. Each participant was invited to bring a caregiver or significant other to the classes, which were held in their PCPs' office. The familiar location made it easier for those attending and likely improved attendance.

The curriculum addressed the essentials of heart failure self-management: What heart failure is and the signs and symptoms; low-sodium diet; medications to manage heart failure; and lifestyle changes to achieve a better quality of life. The Basic Heart Failure Nursing Pocket Guide from the American Association of Heart Failure Nurses served as a guide for the curriculum (Gee et al., 2013). Each participant completed a pre- and postprogram assessment of their knowledge and self-care management. Initially, most participants believed that it was acceptable to skip their diuretic occasionally if they did not have any signs of edema or shortness of breath. Participants also mistakenly believed that a low-sodium diet was the same as a no added salt diet.

The postprogram assessment revealed that participants improved in daily weights, adherence to medications and low-sodium diet, exercise, and stress management.

They were also able to explain heart failure, knew the signs and symptoms of heart failure, and to notify the doctor at early signs and symptoms of exacerbation.

There are many factors that lead to hospitalizations. Patients sometimes lack education about their condition and they don't always practice self-management. Empowering patients to use self-care strategies to manage heart failure can decrease hospital admissions/readmissions. Although this project involved only 29 patients, their postprogram hospitalization rate was 10%. This low rate means less suffering for patients and represents a cost savings.

I urge every home care agency to include at least one certified heart failure nurse on their team. Becoming a certified heart failure nurse establishes you have the knowledge to deliver specialized care to patients. A certification in heart failure can be obtained through the American Association of Heart Failure Nurses. Eligibility for the exam includes working directly with heart failure patients, continuing education courses in heart failure, and preparing for the exam.

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