METHODOLOGY

1. All patients who were admitted or readmitted to BLHC with the diagnosis of CHF were identified by cardiology doctors and invited to attend an educational session about the role of a therapeutic diet in managing their condition. At this session, two PowerPoint presentations were given. For the first presentation, pharmacy residents discussed etiology, symptoms, and medications used in the treatment of the condition. The next presentation covered the nutritional needs required to effectively manage CHF. A Spanish speaking visiting nurse was available throughout the educational session and translated the information for the Spanish-speaking patients. Two standardized questionnaires were then handed out in order to determine whether or not the patient has the ample knowledge, and the willingness, to comply with the diet. One questionnaire was handed out before the educational session, and the second 2 hours after the session. This helped in assessing patient’s retention of the information and determined what areas need to be retaught. All questionnaires were available in English and Spanish. Patient’s medical record was used to assess if these patients were readmitted at BLHC for heart failure within 30 days following this intervention. Design of the study: Single-group, Evaluation pre- and post- test design Statistical Analysis: Descriptive statistics utilizing EXCEL were used to characterize the study population. A percentage method was used to calculate and depict the differences in total compliance and understanding of the self-care before and after education. Inclusion Criteria: Every patient admitted with CHF or newly diagnosed with CHF. Exclusion Criteria: Refusal to participate in inpatient education. Patients with dementia or altered mental status Time frame: 6 weeks Funding; There was no funding available for this intervention METHODOLOGY The primary outcome of the study was to increase the level of patients’ nutritional knowledge. Prior to the education session only 21% of the participants knew how to read food labels in order to determine the desirable amount of sodium per serving they should be looking for in order to maintain their salt intake within the healthy range. The knowledge of the participants significantly increased, resulting in 87% of them successfully determining the recommended amount of sodium per serving. Also, out of 38 participants, none was able to recognize recommended daily intake of sodium prior to the educational intervention, however, 47% of the participants knew the correct answer after attending the class. The data is presented in the graph below. Graph1. The assessment of CHF patients’ knowledge prior and post- education RESULTS CONCLUSIONS Prior to the education session, CHF patients tend to have low levels of knowledge about CHF and lacked an understanding about the affect of a diet on their condition. Improved nutrition related knowledge leads to reduced CHF readmission rates Patients respond well when cultural aspect is considered REFERENCES 1. Halley CM, Hightailing PL, Khalil MK, Thomas JD, Jaber WA. Mortality rate in patients with diastolic dysfunction and normal systolic function. Arch Intern Med. Jun 27 2011;171 (12):1082-7. 2. Rodriguez F; Joynt KE; López L; Saldaña. Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction Am Heart J.  2011; 162(2):254-261 3, Horwitz L, Krumholz H. Heart failure self-management. Up To Date Website. Available at: http://www.uptodate.com/contents/heart-failure-self -management?view. Accessed November 8, 2011. 4. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. Apr 2 2009;360(14):1418-28 5. Joint Commission Website. Available at: http://www.qualitycheck.org/QualityReport.aspx?hcoid=2112&x=nqig&program=Hospital&mst=Heart%20Failure%20Care&f. Accessed November 18, 2011 6. City-data. Com Website. Available at: http://www.city-data.com/city/Bronx-New-York.html. Accessed November 19, 2011. M. van der Wal, D.J. van VeldhuisenF. H. Rutten. Compliance with non-pharmacological recommendations and outcome in heart failure patients. Eur Heart J (2010) 31 (12): 1486-1493 7. Stromberg A. The crucial role of patient education in heart failure. Eur J Heart Fail (2005) 7 (3): 363-369 8. Reducing Hospital Readmissions With Enhanced Patient Education. Fierce Healthcare Custom Publishing. Available at: http://www.bu.edu/fammed/projectred/publications/news/krames_dec_final.pdf. Accessed December 20, 2011 9. Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guidelines. Journal of Cardiac Failure Vol. 16 No. 6 2010 10.P. A. Hines, K. Yu; M. Randall. Preventing Heart Failure Readmissions: Is Your Organization Prepared? Nurs Econ. 2010;28(2):74-86 11.Riegel B, Moser DK, Anker SD. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009;120(12):1141 Following current educational intervention the readmission rate fall from 29.6% to 18%. Patients who attended educational session are less likely to be readmitted with the exacerbation CHF. Congestive heart failure is the number one cause of hospitalization for Medicare patients (1,3). The national U.S. hospitalization rate was 19.6 per 1000 in women over age 64 and 22.9 per 1000 men over age 64 (3). Additionally, approximately 25% of CHF patients are typically readmitted to the hospital within 30 days after discharge(4). It is the most common cause of hospital readmissions and accounts for 34% of cardiovascular-related deaths. The 30-day readmission rate of CHF patients at Bronx Lebanon Hospital Center (BHLC) is 29.6% and it is 4.6% higher than the U.S. national readmission rate (5). Higher admission rates at BLHC may be related to Bronx demographics, since the majority of the Bronx residents are Hispanics (48.4%) and Blacks (31.2%) (6). Considering this, there is a huge need to address the cultural component in educating this particular patient population. Managing CHF is quite complex. Patients have to take multiple medications, follow a low salt diet, weigh themselves daily, and restrict the amount of fluid intake (10,11). Many other factors can contribute to CHF readmissions, including the lack of patient compliance and education regarding their diet and condition, poor communication between medical staff and patient, and very little cultural sensitivity while addressing the patient’s needs. There is a great need to lower the significant volume of CHF readmissions. This will also lead to reduced costs and improve the quality of patient care. Registered dietitians should therefore implement initiatives targeting the reduction of readmission rates for congestive heart failure patients. The purpose of this research project is to determine if adding nutritional component, focused on cultural aspect of the therapeutic diet, will improve knowledge, compliance to the diet and thereby lead to a reduction in readmission rates of CHF patients to the BLHC. Research question: Is there a reduction in readmission of patients with CHF when culturally sensitive diet education is provided during initial admission? Q1. Select foods which are high in salt Q2. While looking at the sodium content on the food label, which product would be desirable choice for you condition (CHF)? Q3. What is your sodium allowance per day? Q4. What is the maximum amount of fluid you are allowed to drink? Q5. What is maximum acceptable weigh gain per week? BACKGROUND Dietetic Intern: IlonaGinevic Mentor: Karen Formato MS, RD, CDN Role of culturally tailored nutrition education on improving CHF patient’s knowledge and preventing heart failure readmissions in BLHC