摘要：Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.
