Therapeutic Patient Education and Short-Term Clinical Outcomes in Chronic Heart Failure: A Prospective Cohort Study at the University Hospital of Brazzaville

Background: Heart failure carries a poor short-term prognosis in sub-Saharan Africa, with high rates of post-discharge mortality partly attributable to modifiable behavioural determinants of decompensation. Therapeutic patient education (TPE) has been proposed as a strategy to reduce these avoidable precipitants, yet evidence on its direct impact on clinical trajectory in African settings remains scarce. Objective: To evaluate the effect of a structured TPE programme on all-cause mortality and cardiac decompensation at three months in patients with chronic heart failure at the University Hospital of Brazzaville. Methods: Prospective cohort study (February-August 2020). Patients were allocated to an educated group (n = 51) receiving a five-session multidisciplinary TPE programme or to a control group (n = 87) receiving usual care. Primary outcomes: all-cause mortality and cardiac decompensation (rehospitalisation) at three months. Secondary outcomes: NYHA functional class progression, blood pressure and heart rate control, lower limb oedema, body weight trajectory, cardiovascular risk factor management, and decompensation triggers. Effect measures included risk ratios (RR), odds ratios (OR), absolute risk reduction (ARR), and number needed to treat (NNT). Results: Mortality was 3.9% in the educated group versus 19.5% in controls (RR = 0.20 [95% CI 0.05 - 0.83]; ARR = 15.6%; NNT = 6.4; p = 0.01). Cardiac decompensation occurred in 7.8% versus 22.9% (RR = 0.34 [0.12 - 0.94]; NNT = 6.6; p = 0.02). Progression to NYHA class III - IV was observed in 13.6% of educated patients versus 36.7% of controls (RR = 0.37 [0.18 - 0.78]; NNT = 4.3; p = 0.03). Tachycardia occurred in 26.5% versus 71.4% (RR = 0.39 [0.24 - 0.61]; NNT = 2.2; p < 0.001). Blood pressure dysregulation affected 22.5% versus 48.3% respectively (RR = 0.46 [0.26 - 0.81]; NNT = 3.9; p < 0.001). Body weight remained stable in the educated group (mean change 0.0 ± 1.2 kg; p = 0.74) but increased significantly in controls (+1.5 ± 2.8 kg; p < 0.001). Good cardiovascular risk factor management was achieved in 75.5% of educated patients versus 18.1% of controls (p < 0.001). Conclusion: Structured therapeutic education was associated with substantial reductions in mortality, cardiac decompensation, functional deterioration, and haemodynamic instability. The consistently low NNT values (2 - 7) across all clinical outcomes support TPE as a high-impact, resource-efficient intervention warranting systematic integration into heart failure management in