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Pre-recorded discharge instructions improve outcomes for heart-failure patients

AHA 2020
Reuters Health - 19/11/2020 - Sending heart-failure patients home from the hospital with pre-recorded audio messages offering support and guidance can help improve their outcomes, according to a new study.

MyROAD - short for My Recorded On-demand Audio Discharge instructions - is a re-playable audio card that includes heart-failure-specific information about diet, physical activity, medication and self-monitoring.

MyROAD contains "consistent, actionable messages related to heart-failure self-care that can be replayed and shared with family members, and this combination may help patients adjust to the transition from hospital to home," Dr. Nancy Albert of the Kaufman Center for Heart Failure at Ohio's Cleveland Clinic said in a presentation at the American Heart Association (AHA) virtual annual meeting.

"Heart failure is a complex condition. When patients are in the hospital, doctors, nurses, care managers and other healthcare professionals meet with patients and their family members to discuss the plan of care. But messages given by different team members may be inconsistent and patients and family members may miss important content or be confused by what they hear," Dr. Albert noted.

Complicating matters, on the day of discharge, heart-failure patients may be distracted as they try to leave the hospital and overwhelmed by the paperwork they receive. MyROAD was developed to help with the hospital to home transition easier, she noted.

Dr. Albert and colleagues tested MyROAD in a randomized controlled trial involving 997 patients (average age 72.8 years, 58.7% male) who were hospitalized with heart failure at four sites in Northeast Ohio. At discharge, 491 patients were randomly allocated to usual discharge care and 506 to usual care plus the MyROAD audio card.

Renal disease was the only characteristic that differed between groups, with the usual-care group having a higher rate than the MyROAD group.

After adjusting for renal disease, the MyROAD group had 27% lower odds (P=0.037) of visiting the emergency department for any cause 30 days after their initial hospital discharge and 29% lower odds at 45 days (P=0.012), compared with the usual-care group, Dr. Albert reported.

At 90 days after discharge, MyROAD users had 41% lower odds (P=0.034) of dying from any cause and a 47% lower odds (P=0.026) of dying from heart failure or needing a left ventricular assist device or cardiac transplant, the authors report in their meeting abstract.

There were no differences between groups in all-cause or heart-failure rehospitalizations. But on the composite endpoint of all-cause rehospitalization, ED visits or death, there were significant drops in risk at both 30 and 45 days in the MyROAD group compared with the usual-care group, Dr. Albert reported.

"The information in this card helped our patients to understand self-care expectations and ultimately decrease bed rates, which is good for patients living with heart failure and also it's good for the healthcare systems," Dr. Albert said.

By Megan Brooks

SOURCE: https://bit.ly/391JMBB American Heart Association (AHA) 2020 Scientific Sessions.

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