Elsevier

Heart & Lung

Volume 29, Issue 5, September–October 2000, Pages 319-330
Heart & Lung

Issues in Cardiac Care
Self-care and quality of life in patients with advanced heart failure: The effect of a supportive educational intervention*,**

https://doi.org/10.1067/mhl.2000.108323Get rights and content

Abstract

Objective: The goal of this study was to determine the effects of a supportive educational nursing intervention on self-care abilities, self-care behavior, and quality of life of patients with advanced heart failure. Design: The study design was an experimental, random assignment. Setting: The study was located at the University Hospital in Maastricht, The Netherlands. Patients: The study included 179 patients (mean age 73 years, 58% men, New York Heart Association classification III and IV) admitted to a university hospital with symptoms of heart failure. Outcome Measures: Outcome measures included self-care abilities (Appraisal of Self-care Agency Scale), self-care behavior (Heart Failure Self-care Behavior Scale), 3 dimensions of quality of life (functional capabilities, symptoms, and psychosocial adjustment to illness), and overall well-being (Cantril’s ladder of life). Intervention: The intervention patients received systematic education and support by a nurse in the hospital and at home. Control patients received routine care. Results: Self-care abilities did not change as a result of the intervention, but the self-care behavior in the intervention group was higher than the self-care behavior in the control group during follow-up. The effect of the supportive educational intervention on quality of life was limited. The 3 dimensions of quality of life improved after hospitalization in both groups, with no differences between intervention and control group as measured at each follow-up measurement. However, there was a trend indicating differences between the 2 groups in decrease in symptom frequency and symptom distress during the 9 months of follow-up. Conclusion: A supportive educational nursing intervention is effective in improving self-care behavior in patients with advanced (New York Heart Association class III-IV) heart failure; however, a more intensive intervention is needed to show effectiveness in improving quality of life. (Heart Lung® 2000;29:319-30.)

Section snippets

Patients

Patients who were admitted to the cardiology unit of the University Hospital of Maastricht with symptoms of heart failure were potentially eligible for the study. After verifying the diagnosis with the Boston score,23 patients were included in the study if they met the following criteria: New York Heart Association (NYHA) functional class III and IV; heart failure diagnosis for longer than 3 months; 50 years of age or older; and Dutch literacy. Patients were excluded from the study if they

Demographic and clinical data

Clinical data were collected from the medical chart of the patient at the time of enrollment. These included medical history, comorbidities, laboratory data, left ventricular ejection fraction, NYHA classification, weight, height, and medications. At the same time the patient was interviewed to collect demographic data (age, sex, marital status, socioeconomic status, social support, and living situation). Patients also completed the 6-minute walk within 48 hours before discharge.

Self-agency and self-care behavior

In this study

Study patients

During May 1994 to March 1997, 828 patients were admitted to the cardiology unit for heart failure. Of these 828 admissions, 184 (22%) were readmissions. Because patients could only enter the study once, 644 patients were screened. Among the remaining 644 patients, 458 (71%) were excluded. Among these, 171 (37%) were excluded because they had been diagnosed with heart failure for less than 3 months, because heart failure was not confirmed by the Boston score (n = 12, 3%), or because they died

Discussion

In this study it was expected that the supportive educational intervention would increase the self-care abilities of patients and would improve the heart failure self-care behavior, which, in turn, would improve patients’ QOL. The intervention was directed toward helping patients to become and remain motivated to comply with the regimen, to ask for help if symptoms worsened, and to adapt their activities. We found a significant improvement in self-care behavior as a result of the intervention;

Limitations of the study instruments

In this study, QOL was reflected by 3 dimensions (functional capabilities, symptoms, and psychosocial adjustment to illness) and measured by the same tools other studies used in comparable populations.14, 15, 34 Although scores of our patients were different from other populations, our instruments may not have been sensitive to change over time. Perhaps a more sensitive and disease-specific instrument with more concise and targeted areas is needed.5 In addition, it is important to use a scoring

Intervention

The intervention was aimed at enhancing self-care agency and self-care behavior through a supportive educational intervention by a nurse. In previous studies,19, 38, 40, 41, 42 comprehensive multidisciplinary programs have been found to have effects on compliance, QOL, and resource use. Although members of other disciplines were consulted in developing the intervention and the study, they were not involved in the actual intervention. Adapting the intervention by a multidisciplinary approach

Conclusions and recommendations

It can be concluded that a supportive educational nursing intervention in the hospital and home is effective in improving self-care behavior of patients with advanced heart failure. Despite the trends of differences in experiences of symptom frequency and symptom distress, the intervention failed to show effectiveness in improving QOL. A stronger “dose” of such an intervention or the inclusion of additional components is needed to improve QOL of these elderly patients with advanced heart

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      The importance of self-management and patient activation and their beneficial effects on health outcomes for individuals with chronic illness has been widely recognized.12,27–32 For HF in particular, previous work has shown that self-management is correlated with higher levels of HF symptom monitoring,33 quality of life,34 and may also be associated with reduced disease severity and symptoms.35,36 For people with HF who are elderly, Vellone et al. showed that self-management was associated with better mental and physical health, better quality of life, and fewer hospitalizations in a large (n = 1192) cohort of elderly individuals with HF (mean age 72 years).37

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    *

    Supported by the Netherlands Heart Foundation, grant 43.033, and Zilveren Kruis, part of Achmea.

    **

    Reprint requests: T. Jaarsma, PhD, RN, Department of Nursing Science, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.

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