The prognostic role of a structured patient education programme among patients hospitalised for heart failure with reduced ejection fraction: To know or not to know, that is the question

Introduction Self-care management is recommended by the 2021 ESC Heart Failure (HF) Guidelines (GLs) for all patients suffering from HF to achieve a more favourable prognosis. Even though structured patient education programmes (PEP) play a strategic role in the complex care of HF patients, their implementation in daily practice remains suboptimal. Aims To assess the effect of a structured, complex PEP on prognosis (all-cause mortality [ACM], HF hospitalisation [HFH], ACM/HFH at 1 year) in a consecutive group of patients hospitalised for HF with reduced ejection fraction (HFrEF), using the propensity-score matching (PSM) method. Patients and methods The data of a consecutive group of 551 HFrEF patients (male: 75%, age: 63 [52-71] years, de novo HF: 42%, LVEF: 25 [20-30]%, NT-proBNP at hospital admission: 5866 [2728-10616] pg/mL, GL-directed medical therapy [GDMT] at discharge: RASi: 94%, βB: 85%, MRA: 95%, SGLT2i: 68%, triple therapy [TT: RASi + βB + MRA]: 82%, quadruple therapy [QT: TT + SGLT2i]: 61%) hospitalised for HF between 2021 and 2025 at our cardiology centre were evaluated. Patients were offered to attend an interactive PEP led by HF specialists and a HF nurse, focusing on the basic characteristics of HF, treatment options, recognition of emergency conditions, and self-care. Patients participating in a structured PEP were matched in a 1:1 ratio with patients not accepting to participate in a structured PEP with adjustment for possible confounders at hospital discharge (female sex, age, de novo HFrEF, coronary artery disease, atrial fibrillation, diabetes, hypertension, systolic blood pressure, heart rate, creatinine-, potassium-, haemoglobin level, LVEF, CRT, RASi-, βB-, MRA-, SGLT2i medication). Before and after PSM, the occurrence of 1-year ACM, HFH, and the composite of ACM/HFH was compared in terms of PEP. Differences in the target dose (TD) application of GDMT in the PSM cohort were also investigated. Results In the total cohort, 1-year ACM (8% vs 19%, p=0.004; PEP vs non-PEP, respectively) and the composite endpoint of ACM/HFH (20% vs 31%, p=0.013) occurred more frequently in the non-PEP subgroup. In the propensity-score matched cohort (n=266), PEP itself led to a 50% reduction of HFH (adjusted HR: 0.498, 95% CI: 0.271-0.913, p=0.024), while no differences were detected in ACM and in the composite endpoint of ACM/HFH at 1 year after PSM. In the PSM subgroup, patients participating in a PEP were more frequently treated with TDs of QT (15% vs 6%, p=0.050), TDs of βB- (29% vs 18%, p=0.044) and TDs of MRA (71% vs 53%, p=0.005) medication at 1 year. Conclusions Our results highlight that structured, complex PEPs should be widely adopted among HF patients, as the presented PSM analysis of real-world HFrEF patients confirmed that PEP itself can reduce the risk of HFH by 50% even within 1 year of follow-up. Moreover, PEP patients were more likely to receive TDs of QT at 1 year.1-year heart failure hospitalisationPharmacotherapy at 1 year