THE EFFECT OF EDUCATION AND FOLLOW UP AFTER DISCHARGE (FAD) ON REDUCING READMISSION RATE OF CHF PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Background: Patients with heart failure (HF) more often visit emergency rooms, are admitted to hospital repeatedly, and have longer lengths of hospitalization. Moreover, inadequate and ineffective follow-up after discharge has increased the risk of unplanned readmissions, which have been a financial burden for healthcare systems. Objectives: The aim of this study was to determine the effects of patient education and post-discharge follow-up on outpatient visits to physician, adherence to medications and hospital readmission rate among HF patients. Methods: This randomized controlled trial was conducted on patients aged 20 and older with diagnosis of heart failure admitted to Taleghani hospital, Tehran, Iran. The patients in intervention group were educated based on recent guidelines and were followed up for 3 months by 9 telephone interviews (every week for the first month after discharge, then every two weeks for the next two months), but the control group received usual care. Every two weeks after discharge, data about main outcome measures were collected by telephone interviews, including frequency of outpatient visits to physician, frequency of readmissions and adherence to medications. Results: Overall, 190 patients were screened and 120 patients were allocated equally with block randomization method. Readmission rate was 19.3% in intervention and 38.2% in control group (P-value = 0.05, odds ratio = 2.21). Outpatient visits was not significantly different between both groups (17.5% in intervention vs 28.3% in control group). In intervention group, 94.7% of patients and in control group, 84.9% of patients took medications completely as prescribed, which was not statistically significant. Conclusion: In the present study, post-discharge intervention was effective on reduction of readmission rate among HF patients.