Effects of educational intervention on mortality and patient-reported outcomes in individuals with heart failure: A randomized controlled trial

ObjectiveTo examine the effects of an educational intervention on patient-reported outcomes and all-cause mortality in heart failure (HF) patientsMethodsIn this randomized controlled trial, we enrolled 122 hospitalized patients with HF. The intervention group (n = 60) received an individual nurse-led education session on HF self-management during hospitalization and three telephone calls after discharge. The control group (n = 62) received care as usual. Patient-reported outcomes were measured at baseline and at 3 and 6 months. Mortality status was determined using the National Death Records. Intervention effects were evaluated using the Cox proportional hazards regression model and linear mixed models.ResultsDuring the follow-up (median: 568 days), 7 deaths (12%) in the intervention group and 15 deaths (24%) in the control group occurred (adjusted hazard ratio, 0.40; 95% confidence interval, 0.16–0.98; P = .046). From baseline to 3 and 6 months, the intervention group showed greater improvements in HF knowledge (difference=6.14, P = .03; difference=5.76, P = .02, respectively), self-care (difference=?6.08, P < .001; difference=?6.16, P < .001, respectively), and health-related quality of life (difference=?11.90, P = .01; difference=?14.57, P = .004, respectively) than the control group.ConclusionEducational intervention with telephone follow-up reduced all-cause mortality and improved patient-reported outcomes.Practice implicationEducational intervention should be considered as part of routine care for HF patients.     

The effect of nurse-led education on hospitalisation,readmission, quality of life and cost in adults with heart failure. A systematic review

Objective

The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community.

The effect of education through motivational interviewing compared with conventional education on self-care behaviors in heart failure patients with depression

ObjectiveTo determine the effect of education based on motivational interviewing on self-care behaviors in heart failure patients with depression.MethodsIn this study, 82 patients suffering from heart failure whose depression had been confirmed were selected and divided into two groups. The Self-Care Heart Failure Index was utilized to evaluate self-care behavior. The intervention group received four sessions of self-care behavior education based on the principles of motivational interviewing, and the control group received four sessions of conventional education on self-care behavior. At 8 weeks after finishing the interventions, the self-care behaviors of both groups were evaluated. Data were analyzed using paired and independent t-tests, Chi-square, and analysis of covariance, as appropriate.ResultsThe average increase in the overall scores and the scores on the three sub-scales of self-care behavior (maintenance, management, and confidence) of the heart failure patients with depression were significantly higher after education based on motivational interviewing than after conventional self-care education (p < 0.05).ConclusionsMotivational interviewing had a significant positive effect on self-care behaviors in patients with heart failure and depression.Practice implicationsDue to the effectiveness of the MI, using motivational interviewing for education in depressed HF patients is recommended.     

The role of peer support education model on the quality of life and self-care behaviors of patients with myocardial infarction

ObjectiveThis study aimed to assess the effect of peer education on the quality of life and self-care behaviors of patients with myocardial infarction.MethodsIn this clinical trial, 70 patients with myocardial infarction meeting the inclusion criteria were assigned to experimental (n = 35) or control (n = 35) groups using block randomization. Patients in the intervention group received two one-hour training sessions on the third day after myocardial infarction during the CCU stay along with routine care. Education intervention was performed by peers. The control group will follow routine care. All patients selected were assessed using McNews' quality of life questionnaire and Miller self-care questionnaire, respectively before the intervention and also one month after discharge. Chi-square and t-test were used to analyze the data.ResultsAfter the intervention, the mean of quality of life and the mean score of self-care behaviors in the experimental group were significantly higher compared to the control group.ConclusionsAccording to the results, to improve the quality of life and promote the self-care behaviors in such patients, using peer education along with healthcare professionals is recommended.Practice ImplicationThis patient education approach had a significant impact on quality of life and self-care behavior.     

Effect of family nursing therapeutic conversations on health-related quality of life,self-care and depression among outpatients with heart failure: A randomized multi-centre trial

Objective

To evaluate the short-term (3 months) effects of family nursing therapeutic conversations (FNTC) on health-related quality of life, self-care and depression in outpatients with Heart failure (HF).

Comparison of self-care behaviors of heart failure patients in 15 countries worldwide

Objective

Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents.

Methods

Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale.

Results

In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries.

Conclusion

Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide.

Practice implications

Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.     

Physical exercise improves the functional capacity and quality of life in patients with heart failure

OBJECTIVE: The purpose of this study was to investigate the effects of physical exercise on the functional capacity and quality of life in heart failure patients. METHODS: Forty-two patients of both sexes with heart failure of NYHA class II and III with different etiologies were randomly divided into untrained or trained groups. The six-month exercise program consisted of aerobic training, muscle strength training, agility and joint flexibility activities. Physical fitness was evaluated by testing the performance on these trained components. Quality of life was evaluated by scored answers to a standardized questionnaire involving multiple domains. RESULTS: Baseline values did not differ between groups. Improvement in the trained group was identified in all components of functional capacity when compared to the untrained group (p<0.001). Quality of life improved in the trained patients concerning physical, psychological, social and environmental domains (p<0.001), whereas no significant change was found in the untrained patients. CONCLUSIONS: Guided and monitored physical exercise is safe and has the potential to improve functional capacity and quality of life in heart failure patients with multiple etiologies.     

Peer support interventions on quality of life,depression, anxiety,and self-efficacy among patients with cancer: A systematic review and meta-analysis

ObjectivePeer support is a common form of social support that is provided by individuals with the same disease, which is cost-effective and has enhanced health outcomes for patients. This study aimed to determine the effectiveness of peer support interventions on quality of life (QOL), depression, anxiety, and self-efficacy among patients with cancer.MethodsA systematic search of seven databases were conducted from inception to January 2021. Studies were screened and assessed by two independent reviewers. Data synthesis was conducted using RevMan 5.3 software, and the standardized mean difference was used to calculate pooled effect sizes.ResultsSeventeen studies were included in current review. The meta-analysis indicated significant beneficial effects of peer support on QOL (SMD = 0.48, 95% CI 0.21–0.75; p < 0.001), depression (SMD = ?0.23, 95% CI ?0.39 to ?0.07; p = 0.005), anxiety (SMD = ?0.24, 95% CI ?0.45 to 0.03; p = 0.03), and self-efficacy (SMD = 0.22, 95% CI 0.03–0.42; p = 0.03) relative to controls. The subgroup analysis for QOL revealed that peer support delivered in the mixed mode contributed more than peer support delivered in the single mode (e.g., face-to-face or telephone).ConclusionPeer support has significant effects on improving QOL and self-efficacy as well as alleviating depression and anxiety among patients with cancer. Additional randomized controlled trials with rigorous design and larger sample sizes are warranted in the future.Practice implicationsPeer support programs might benefit patients with cancer and could be used as a complementary approach to traditional healthcare services during cancer rehabilitation.     

Evaluation of the effectiveness of the healthy heart tracker on heart failure self-care

ObjectiveWe evaluated the effectiveness of a newly designed patient education booklet, the Health Heart Tracker (HHT), in promoting Heart Failure Self-Care (HFSC) behaviors compared to usual patient discharge handouts.MethodsWe conducted a quasi-experimental, comparative two-group study using patients admitted for HF to four intermediate care units. The HHT was instituted on two units; patients on the other units served as control. We analyzed HFSC measured prior to HF discharge education and at two and six weeks post discharge using repeated measures ANOVA.ResultsEighty-four 84 patients completed the study. The sample was 72.6 (+ 12.9) years old, white (75%), educated, and retired (85.8%). All HFSC behaviors improved significantly over time, but there were no significant time by group interactions in HFSC maintenance, symptom perception, and confidence. A notable increase in HFSC management in the HHT group between baseline and 2 weeks was evident, but not sustained to 6 weeks.ConclusionsA focused, singular intervention in the form of a patient education booklet designed specifically to improve HFSC did not significantly improve self-care behaviors over time compared to a control group.Practice ImplicationsMore work is needed to determine optimal written resources for patients with HF.     

The role of patient attachment and working alliance on patient adherence, satisfaction, and health-related quality of life in lupus treatment

Objective

Researchers tested the hypothesis that patients’ working alliance with their physicians, and patients’ attachment styles would predict patients’ adherence, satisfaction, and health-related quality of life.

Methods

One hundred ninety-three patients diagnosed with lupus participated in an online survey. They completed measures of the Physician–Patient Alliance Inventory, Experiences in Close Relationships Scale, SF-36, General Adherence Inventory, and the Medical Patient Satisfaction Questionnaire.

Results

Working alliance was significantly and positively associated with all three outcome variables of adherence, satisfaction, and quality of life. Attachment avoidance was significantly and negatively related to adherence, and attachment anxiety was significantly and negatively related to health-related quality of life.

Conclusions

A working alliance between physician and patient, characterized by agreement communication on goals and tasks of treatment, along with trust and patient liking of his/her doctor, predicts patient adherence, satisfaction, and quality of life. Psychological dimensions of attachment also predict patient adherence and quality of life.

Practice implications

Doctors and other health service providers ought to actively set goals and tasks of treatment, and foster patient trust and liking. A strong relationship with patients can increase treatment efficacy and effectiveness and improve outcomes for individuals with debilitating chronic illnesses such as lupus.     

Efficacy of a social support and problem-solving intervention on heart failure self-care: A pilot study

Objective

The purpose of this study was to examine the preliminary effects of a coping partnership intervention comprised of social support and problem-solving on HF self-care maintenance, management, and confidence.

Evaluation of first-person storytelling on changing health-related attitudes,knowledge, behaviors,and outcomes: A scoping review

ObjectivesFirst-person storytelling (FPS) has the potential to engage patients in changing behavior differently than didactic education. We assessed the prevalence of FPS in health education interventions; whether published FPS research has shown improvements in attitudinal, knowledge, behavioral, or clinical outcomes; and whether randomized controlled trials (RCTs) including FPS have shown more effectiveness than non-FPS interventions.MethodsA scoping review of FPS studies published before October 2019 in five medical databases was conducted.Results22 out of 10,363 identified studies met eligibility criteria. FPS has been studied primarily in cancer, diabetes, and hypertension. Of the 12 RCTs, compared to controls, patients receiving FPS interventions improved attitudes (N = 6 studies) and knowledge (N = 1), improved health behaviors like quitting smoking (N = 6), and improved clinical outcomes like lowering A1C levels (N = 3). Of the 10 non-RCT studies, compared to baseline assessments, patients who received FPS interventions had improved knowledge (N = 1), attitudes (N = 3), clinical outcomes (N = 4), and improved health behaviors (N = 7).ConclusionWhile rarely used, FPS interventions can improve patient health attitudes and outcomes. Future research should expand FPS to new health areas and determine best practices for developing FPS interventions.Practice ImplicationsFPS may be particularly effective with low income patients and racial/ethnic minorities.     

Fatigue self-management education in persons with disease-related fatigue: A comprehensive review of the effectiveness on fatigue and quality of life

ObjectivesTo systematically synthesize the effectiveness of fatigue self-management education (SME) on fatigue and quality of life (QoL) in persons with disease-related fatigue, and to describe the intervention characteristics.MethodsWe systematically reviewed the literature on SMEs in people with disease-related fatigue. We included randomized controlled trials (RCT), which aimed to improve self-management skills for fatigue in daily life. We synthesized the effectiveness and mapped the intervention characteristics.ResultsWe included 26 RCTs studying samples from eight disease groups. At follow-up, 46% studies reported statistically significant improvements on fatigue and 46% on QoL. For persons with cancer 6/8 and multiple sclerosis 8/10 RCTs showed positive evidence in favor of SME. The range of effect sizes was wide (d: 0.0 ->0.8). Delivery modalities (inpatient, outpatient, home), interactions (individual, group, remote), and duration [range (h): 1–17.5] varied.ConclusionsThe overall evidence on the effectiveness of SMEs on fatigue and QoL is limited and inconsistent. For persons with cancer and multiple sclerosis, the evidence provides a positive effect. The RCTs with medium to large effect on QoL indicate the potential benefit of SMEs.Practical implicationDuration and peer interaction should be considered when tailoring SMEs to populations and contexts.     

Effects of tibolone and raloxifene on health-related quality of life and sexual function

OBJECTIVES: Study to compare the effects of tibolone and raloxifene on health-related quality of life, sexuality and vaginal atrophy. METHODS: A double-blind, randomized study was conducted in 308 osteopenic, but otherwise healthy, postmenopausal women (mean age 66 years) who received tibolone 1.25mg/day or raloxifene 60 mg/day for 2 years. Health-related quality of life was assessed by the women's health questionnaire (WHQ), sexual function by the McCoy female sexuality questionnaire (MFSQ) and vaginal atrophy by assessing the karyopycnotic index (KI) and vaginal maturation (VM). RESULTS: At week 104, the tibolone group showed a trend towards an improved health-related quality of life (HRQoL) mean score in eight out of nine WHQ domains. HRQoL scores approximated values for premenopausal women, being pre-defined as "clinically relevant". The raloxifene group showed a trend to a diminished HRQoL mean score from baseline to week 104. No difference could be assessed between the tibolone and raloxifene group in mean total score and separate domains' scores of the MFSQ, except for the vaginal lubrication domain (p=0.037). The increase in KI and VM was statistically significantly greater with tibolone than with raloxifene (for both KI and VM p<0.0001). Tibolone and raloxifene were equally well tolerated. CONCLUSIONS: In older postmenopausal women, tibolone treatment showed a trend towards an improvement in quality of life and sexuality when compared to raloxifene.     

Patients are expecting to learn more: A longitudinal study of patients with heart failure undergoing device implantation

ObjectiveTo explore the educational expectations and experiences of patients with heart failure in relation to device implantation.MethodsIn this longitudinal study, patients at six Swedish and Icelandic hospitals answered instruments about their knowledge expectations, before the device implantation, and about the knowledge they had received at two weeks, six months and 12 months after the procedure. Predictors for fulfillment of knowledge expectations were assessed with linear mixed model analysis.ResultsPatients (N = 133, mean age 69.8 (±9.7) years, 80 % men) had high knowledge expectations, which for 83 % of them were unfulfilled. Predictors for fulfillment of knowledge expectations were access to knowledge from healthcare professionals (β 0.74, 95 % CI: 0.42–1.10), educational level (β −0.30, 95 % CI: −0.52 to −0.07) and knowledge expectations (β -1.03, 95 % CI: −1.30 to −0.80). Healthcare professionals were the main information source (89 %), 74 % of patients received written information, and 19 % had used the Internet.ConclusionsPatients receive less knowledge than they expect, and individual factors and communication with healthcare professionals are related to their experience. Face-to-face is the most common method of delivering education.Practice implicationsHealthcare professionals should assess patients’ expectations for information and consider implementing more diversity in their educational practices.     

Relationship between improvements in heart failure patient disease specific knowledge and clinical events as part of a randomized controlled trial

Objective

To examine the changes in performance on heart failure knowledge assessments administered before and after discharge education.

Methods

We conducted a randomized controlled trial comparing the effects of a 1-h, one-on-one teaching session with a nurse educator to the standard discharge process in patients with systolic heart failure. Patients completed a 30 point heart failure knowledge questionnaire (HFKQ) prior to and 3 months after the education intervention.

Results

Patients randomized to the nurse education intervention (n = 113) demonstrated significantly higher total HFKQ score increases compared to patients receiving the standard discharge process (n = 114) (median, IQR 1, 0 to 4 vs 0, −2 to 2, p = 0.007). Patients experiencing death or rehospitalization in the subsequent 6 months were found to have significantly lower HFKQ scores (10, 7 to 12 vs 11, 8 to 13, p = 0.002) compared to patients without a clinical event.

Conclusion

Heart failure nurse education at the time of hospital discharge results in improved patient knowledge and reduced risk of readmission.

Practice implications

Health care personnel should encourage education sessions for heart failure patients. Resources possibly need to be allocated for nurse led education sessions in heart failure patients as it improves outcomes and knowledge.     

Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme

Objective

The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life.

Methods

Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life.

Results

In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up.

Conclusion

Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme.

Practice implications

These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.     

The efficacy of psychologically based interventions to improve anxiety, depression and quality of life in COPD: A systematic review and meta-analysis

Objective

To systematically evaluate the efficacy of psychologically based interventions for addressing psychological outcomes in patients with chronic obstructive pulmonary disease (COPD).

Methods

Electronic databases, key journals and reference lists of included studies were scrutinised for inclusion; in addition authors were contacted for potential unpublished research. Nine studies were identified for inclusion. Data was extracted by two reviewers independently using a standardised extraction sheet and a series of meta-analyses completed for measures of anxiety, depression and quality of life.

Results

Eight studies evaluated a cognitive behavioural- or psychotherapeutically based intervention and one study evaluated taped progressive muscle relaxation. The studies revealed some evidence for the interventions’ impact on anxiety, but, taken together interventions had limited effectiveness. The meta-analyses that were conducted revealed a small effect for anxiety only.

Conclusion

The results are discussed considering the limitations of the research and previous work in this area. A systematic evaluation of psychological interventions on psychological co-morbidity in patients with COPD is recommended.

Practice implications

There is some evidence that psychological interventions impact anxiety and this should be explored further and more interventions should target quality of life.