Patient-Centered Communication and Outcomes in Heart Failure

OBJECTIVES: To measure the impact of patient-centered communication on mortality and hospitalization among patients with heart failure (HF).

STUDY DESIGN: This was a survey study of 6208 residents of 11 counties in southeast Minnesota with incident HF (first-ever International Classification of Diseases, Ninth Revision code 428 or International Classification of Diseases, Tenth Revision code I50) between January 1, 2013, and March 31, 2016.

METHODS: Perceived patient-centered communication was assessed with the health care subscale of the Chronic Illness Resources Survey and measured as a composite score on three 5-point scales. We divided our cohort into tertiles and defined them as having fair/poor (score<12), good (score of 12 or 13), and excellent (score≥14) patient-centered communication. The survey was returned by 2868 participants (response rate: 45%), and those with complete data were retained for analysis (N=2398). Cox and Andersen-Gill models were used to determine the association of patient-centered communication with death and hospitalization, respectively.

RESULTS: Among 2398 participants (median age, 75 years; 54% men), 233 deaths and 1194 hospitalizations occurred after a mean (SD) follow-up of 1.3 (0.6) years. Compared with patients with fair/poor patient-centered communication, those with good (HR, 0.70; 95% CI, 0.51-0.97) and excellent (HR, 0.70; 95% CI, 0.51-0.96) patient-centered communication experienced lower risks of death after adjustment for various confounders (P_trend=.020). Patient-centered communication was not associated with hospitalization.

CONCLUSIONS: Among community patients living with HF, excellent and good patient-centered communication is associated with a reduced risk of death. Patient-centered communication can be easily assessed, and consideration should be given toward implementation in clinical practice.