The Comparison of the Effects of Education Provided by Nurses on the Quality of Life in Patients with Congestive Heart Failure (CHF) in Usual and Home-Visit Cares in Iran (original) (raw)
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Care in the Home for the Management of Chronic Heart Failure
Journal of Cardiovascular Nursing, 2015
Background: The objective of this study was to determine the effect of care in the home (CHM) compared with usual care (UC) in patients with chronic heart failure (CHF) on clinical outcomes and healthcare use including a cost-effectiveness analysis. Methods: A systematic literature search on MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, as well as Centre for Reviews and Dissemination was conducted to identify randomized controlled trials comparing CHM with UC in CHF. The randomized controlled trials meeting inclusion criteria were meta-analyzed by outcome, and the quality of evidence for each outcome was evaluated using Grading of Recommendations Assessment, Development, and Evaluation system. A cost-effectiveness model was developed to estimate costs and quality-adjusted life years. Results: Six randomized controlled trials were identified from 1277 citations. Care in the home was predominately provided by a single health professional consisting of nurse-led education of varying duration and frequency. One study included pharmacist-led CHM. Care in the home showed a decreased risk for all-cause mortality and hospitalizations combined (risk ratio, 0.88; 95% confidence interval [CI], 0.80Y0.97), but not all-cause mortality alone (risk ratio, 0.92; 95% CI, 0.81Y1.04). Care in the home resulted in fewer hospitalizations (mean difference, j1.03; 95% CI, j1.53 to j0.53) and fewer emergency department visits (mean difference, j1.32; 95% CI, j1.87 to j0.77). Quality of life also improved with CHM delivered by nurses. Critical appraisal of the quality of evidence suggests uncertainty in the estimates for a number of outcomes. Care in the home resulted in a savings of $10,665 and a gain of 0.11 quality-adjusted life years compared with UC. Conclusions: In conclusion, the beneficial effect of CHM in CHF is by reducing mortality and hospitalizations combined. Care in the home in CHF seems to be more effective and less costly compared with UC.
Heart failure: tools for nursing and medical treatment
Cardiology journal, 2011
To validate a structured interview designed to evaluate the healthcare and information needs of patients with heart failure (HF), who were also characterized by means of the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 36-item Short-Form Health Survey (SF-36). Forty-five in- and outpatients with HF were administered a structured interview concerning their information and healthcare needs (together with the KCCQ and SF-36) with the aim of investigating the effects of healthcare models on their quality of life (QoL). Twenty-one patients were also involved in a one-week test-retest validity study carried out in order to verify reproducibility and stability by means of concordance and K statistics. The reproducibility of the structured interview was good or very good for all items, with a mean Kw of 0.59; the clarity and acceptability of most of the questions were good. Positive judgements of hospital care inversely related to the patients' New York Heart Association clas...
Quality of Life of Individuals With Heart Failure
Medical Care, 2002
BACKGROUND. The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses. METHODS. A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-tohome and supportive care for self-management 2 weeks after hospital discharge. RESULTS. At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 ؎ 19.1 SD) than among the Usual Care patients (37.5 ؎ 20.3 SD; P ؍ 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6-and 12weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P ؍ 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (2 ؍ 4.86, df 1 , P ؍ 0.03).
Circulation, 2006
Background-The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown. Methods and Results-The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (nϭ149) or usual postdischarge care (UC) (nϭ148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; PϽ0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; PϽ0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; PϽ0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04Ϯ3.23 versus 3.66Ϯ7.62 admissions; PϽ0.05) and related hospital stay (14.8Ϯ23.0 versus 28.4Ϯ53.4 days per patient per year; PϽ0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional
Revista española de cardiología, 2007
To determine the effectiveness of a primarily educational intervention in heart failure (HF) patients implemented in a home care unit. This randomized controlled clinical trial involved 279 HF patients who were discharged from a tertiary-care hospital between February 2001 and June 2002. Patients with dementia, terminal non-cardiac disease, or chronic obstructive pulmonary disease were excluded. Data collected included the cause of cardiac decompensation. A primarily educational intervention was implemented in the patient's home for up to 15 days after hospital discharge. Treatment was adjusted during the first week if necessary. The primary outcome measure was the 1-year cumulative incidence of readmission or death. Secondary measures were the incidence of readmission, mortality, and emergency department admission. Telephone interviews were carried out 3, 6 and 12 months after discharge, and clinical records were updated when necessary. Emergency department admission in the fir...
Nurse-led interventions in heart failure care: Patient and nurse perspectives
European Journal of Cardiovascular Nursing, 2010
Background: Perspectives of nurses and patients on the intensity and content of disease management programmes (DMPs) in heart failure are seldom addressed but are important in optimizing these programmes. Aim: To describe the perspectives of patients and nurses on delivered care in two DMPs. Methods: In total 442 patients (62% male; age 68 ± 12 years; LVEF 33% ± 14), assigned to the intervention groups of the Coordinating Study Evaluating Outcomes of Advising and Counselling in HF (COACH), and 32 registered nurses, completed questionnaires on satisfaction with the intensity and components of the DMPs. Results: In spite of large differences in intensity and components, patients were satisfied with the content of both DMPs. In patients (NYHA III-IV), treatment and educational goals were more often achieved in those who received intensive support, compared to patients who received basic support (85% vs. 70%). Patients and nurses perceived that most home visits were adding significant value to the HF care, while 12% of the home visits were perceived as unnecessary by the nurses. Conclusion: Patients and nurses did not perceive the intense DMP as an emotional and physical burden for themselves. Patients with severe HF might be in need of more support to achieve optimal treatment and educational goals.
Contributions Of Nurses In Health Education Of Patients With Heart Failure
International Archives of Medicine, 2016
Objective: to identify how health education actions performed by the nursing professional contribute to the improvement of the quality of life of patients with heart failure. Method: Integrative review built from the following question: What contributions of the nurse in the health education of patients with heart failure? Made in the PUBMED, LILACS and SciELO Virtual Library databases. The studies were analyzed and presented in a descriptive and table format. Results: 8 studies were the sample. It was possible to identify that the actions of health education developed by nurses to patients with heart failure provide integration of the patients with the family, behavior change and acquisition of healthy habits.