Abstract
BackgroundThe prevalence of cardiovascular disease is increasing. Improved treatment options increase survival after an acute myocardial infarction or sudden cardiac arrest, although patients often have difficulty adjusting and regaining control in daily life. In particular, patients who received an implantable cardioverter defibrillator (ICD) experience physical and psychological problems. Interventions to enhance perceived control and acceptance of the device are therefore necessary. This paper describes a small-scale study to explore the feasibility and the possible benefits of a structured nurse- and peer-led self-management programme ('Chronic Disease Self-Management Program' – CDSMP) among ICD patients.MethodsTen male ICD patients (mean age = 65.5 years) participated in a group programme, consisting of six sessions, led by a team consisting of a nurse specialist and a patient with cardiovascular disease. Programme feasibility was evaluated among patients and leaders by measuring performance of the intervention according to protocol, attendance and adherence of the participating ICD patients, and patients' and leaders' opinions about the programme. In addition, before and directly after attending the intervention, programme benefits (e.g. perceived control, symptoms of anxiety and depression, and quality of life) were assessed.ResultsThe programme was conducted largely according to protocol. Eight patients attended at least four sessions, and adherence ranged from good to very good. On average, the patients reported to have benefited very much from the programme, which they gave an overall report mark of 8.4. The leaders considered the programme feasible as well. Furthermore, improvements were identified for general self-efficacy expectancies, symptoms of anxiety, physical functioning, social functioning, role limitations due to physical problems, and pain.ConclusionThis study suggests that a self-management programme led by a team consisting of a nurse specialist and a patient with cardiovascular disease seems feasible according to both patients and leaders. The programme may improve general self-efficacy expectancies, symptoms of anxiety, and quality of life (physical functioning, social functioning, role limitations due to physical problems, and pain) as well. Further investigation of the programme's effectiveness among a larger sample of ICD patients or other patient groups with cardiovascular disease, is recommended.
Highlights
The prevalence of cardiovascular disease is increasing
Aim This study presents the first exploration of the feasibility and the possible benefits of a Dutch nurse- and peer-led version of the structured Chronic Disease SelfManagement Program' (CDSMP) in a small group of implantable cardioverter defibrillator (ICD) patients
Patients' mean left ventricular ejection fraction was 32%, of whom the majority had suffered from at least one myocardial infarction prior to ICD implantation (n = 9) and experienced New York Heart Association (NYHA) Class II-III symptoms based on results of exercise tests (n = 8)
Summary
Improved treatment options increase survival after an acute myocardial infarction or sudden cardiac arrest, patients often have difficulty adjusting and regaining control in daily life. The prevalence of CVD is increasing because of changed life expectancies, unhealthy lifestyles, and improved treatment options [2,3]. Because of these improved therapies, patients suffering from acute myocardial infarction have a considerably higher chance of survival. A substantial number of CVD patients receive an implantable cardioverter defibrillator (ICD), making it one of the most important recent advanced therapies in the prevention of sudden cardiac arrest due to life-threatening arrhythmias [4,5]. In the majority of these studies, the lack of positive results may be explained partly by the small sample sizes and possibly by the unstructured format of several of the interventions [11]
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