Nurse-based educational intervention in a heart failure unit improves outcomes in self-care, quality of life and depression of high-risk patients with chronic heart failure

Abstract

Purpose: Self-care management is an important part of Heart Failure (HF) treatment. Multidisciplinary management programmes in Heart Failure Units (HFU) have been encouraged by the latest European Guidelines on Chronic HF. However, no clear interventions have been proved to be effective and tailored different programmes are used in every country. The purpose of this study was to evaluate the impact of a nurse-based educational intervention (NEI) on quality of life of high-risk patients with Chronic HF. Methods: We included patients admitted at our HFU after a HF episode that required hospitalization from February 2011 to October 2012. After discharge and treatment optimization, patients and their carers were offered a 4-weeks NEI. Patients with motility limitations or no possible self-access to our centre were excluded. Standardized tests to measure performance in activities of daily living, cognitive impairment and co-morbidity were performed. Self-care (The European Heart Failure Self-care Behavior (ESS)), quality of life (Minnesota living with heart failure questionnaire (MQ)) and degree of depression, (Yessavage's Geriatric Scale (YS)) were measured and compared pre and 3 months post-NEI. NEI consisted of four weekly consecutive sessions with brochures and audio-visual support that included topics as promoting self-care, recognition of alarm signs and symptoms, flexible diuretic regimen, diet/regular exercise aspects, pharmacological treatment, importance of psychological aspects etc. Results: From 408 patients visited in our HFU during this time, 107 patients (26%) were included in our NEI. 74% were men, mean age was nearly 70 years (range 43-89 years). Mean left ventricle ejection fraction was 31±8%, 91% were on NYHA class II-III and 97% were on ECA-inhibitors/ARB. Included patients were mostly independent in daily living (Barthel mean score (MS):98,5±5,8), without significant cognitive impairment (Pfeiffer's test MS: 0,94±0,52) and with moderate degree of co-morbidities (Charlson co-morbidity index MS: 5,27±2,27). After NEI, our patients showed a statistically significant improvement in quality of life (MQ MS reduction: 3,79, p<000,1), a better self-care (ESS MS reduction: 6,12, p<0,001) and lesser degree of depression (YS MS reduction: 3,36 p=0,001). Conclusions: NEI improved self-management, quality of life and depression symptoms in patients with Chronic HF. This is an important benefit for this special, high-mortality, easily-decompensated population that can suppose an economical cost-reduction for health-care systems. NEI should be promoted to benefit these patients.