Patient Education Leads to Better Care for Heart Patients

AS the nation's economists join leaders in the health field in looking for ways to halt spiraling hospital cost3, one avenue of approach that holds great promise for further exploration is well-organized treatment and education programs for patients. Recognizing that congestive heart failure is an important public health problem, particularly in persons over 60, the staff of the heart and circulatory disease program, New Jersey State Department of Health, initiated a special heart project early in 1964 (1). The project was conducted at St. Peter's General Hospital, New Brunswick, N.J., from 1964 to 1966. In essence, the New Jersey study showed that an education program for 50 patients with congestive heart failure increased the patient's knowledge of his disease, medication, and diet as well as his adherence to a prescribed regimen. When studied against the previous experiences of these patients as well as against the experiences of a control group, readmissions and total readmission days were significantly reduced. It is known that a myocardial infarction may precede the onset of decompensation and congestive heart failure. Other causes may be acute rheumatic carditis, infections, and pulmonary embolus. In many if not most recurrences, none of these rather obvious causes have existed. Other factors that might precipitate an acute bout of congestive heart failure are stress, dietary indiscretions, failure to take medication as prescribed, and failure to follow limitations in activity. Each study patient had a history of congestive heart failure, characterized by recurrent attacks requiring immediate hospitalization, which might be prolonged into a period of weeks. Such recurrences disrupted the patient's life, were costly to him and to his family or to the community, and caused him acute anxiety because of the fear of recurrences, which might result in death.