Education and Management of the Whole Patient

Abstract

Given the magnitude of heart failure as a public health problem, with 5 million affected patients and its recognition as the most costly cardiovascular illness in the United States, efforts are needed to enable patients to live optimally with the disease, avoiding costly and preventable recurrent hospitalizations (1). Nearly 50% ofrehospitalizations are preventable (2, 3). An analysis of International Classification of Diseases-9th Revision (ICD-9) codes associated with heart failure admissions identified 16 codes that are modifiable through improved patient self-care. These include volume depletion or overload, hyper and hypopotassemia, edema, orthopnea, dyspnea, and poisoning by agents such as cardiac glycosides (4). Factors prompting readmission include inadequate discharge planning, and patient behaviors such as failure to adhere to diet restrictions, take medications appropriately, and report symptoms promptly (3, 5–7). Nonadherence is greatest in patients who lack motivation and strong social-support systems (5). In a study of more than 7000 patients with newly prescribed digoxin, only 10% had filled enough prescriptions to ensure daily dosing (8). Other authors in this volume describe the significant advances in therapies that promise both to prolong life and increase its quality.