Autocuidado de pacientes com insuficiência cardíaca após alta hospitalar no estado de Sergipe: ensaio clínico randomizado

Abstract

Heart failure (HF) is the final common pathway of most heart diseases and is a complex clinical syndrome characterized by functional or structural heart disorder. As a way to improve the quality of life of individuals with this disease, good self-care practices can beneficially change this scenario. The study aims to evaluate the impact of an educational intervention on the self care of patients with decompensated HF after hospital discharge, as well as on the number of readmissions and mortality. This is a randomized and controlled clinical trial, registered as RBR-8dymr8 in Clinical Trials, guided by CONSORT, approved by the Ethics and Research Committee (opinion 5,565,107). The study was conducted in 6 hospitals in Sergipe. Eligible patients were randomized to the Control Group (CG) or Intervention Group (IG). Patients in the IG were monitored and guided by nurses in person (before discharge, 7, 30, and 60 days after discharge) and by telephone (15 and 45 days after discharge). Patients in the CG followed routine follow-up and assessment at 60 days after discharge. The intervention consisted of an educational booklet with guidelines on HF after hospital discharge, and a self-care questionnaire was also applied, considering it adequate when the score per section was ≥ 70 points. All statistical analyses were performed using the R programming environment (version 4.3.2) and the significance level adopted was 5%. The data correspond to the period from September 2022 to November 2024. During this period, 330 patients were hospitalized for decompensation, 201 were collected, 86 were randomized, and 60 completed the 60-day follow up, 31 in the CG and 29 in the IG. There was a predominance of men, over 60 years old, brown, married, hypertensive and diabetic, valvular or ischemic etiology, functional class II or III, with reduced ventricular ejection fraction. There were fewer readmissions in IG (CG 38% vs IG 28%), with longer time after discharge (CG 19±14 days vs IG 28±12 days), shorter readmission duration (CG 20±13 days vs IG 18±13 days) and predominance of non-cardiac cause (CG 80% vs IG 63%). There were 4 deaths, 2 in each group. The intervention was significantly effective for adequate self-care in sections A and C (Section A 76% vs 10%; Section C 66% vs 13%). It was not possible to evaluate the impact of the intervention on the mortality outcome. Patients followed in person and by telephone benefited from the adopted strategy and had fewer readmissions and improved self-care compared to the CG.