Further research is necessary to study how long-term effectiveness of the programme with patients with congestive heart failure can be achieved, and how successful adaptations of the programme can be integrated into standard care.

AimsThe 'Chronic Disease Self-Management Programme' (CDSMP) emphasizes patients' responsibility for the day-to-day management of their condition(s) and has shown favourable effects on health behaviour and healthcare utilization among various groups of patients with chronic conditions. However, the effects of the CDSMP among congestive heart failure (CHF) patients are unknown. We therefore aimed to assess the effects of the CDSMP on health behaviour and healthcare utilization in patients with CHF. Methods and resultsThis randomized, controlled trial with 12 months of follow-up included 317 CHF patients with a slight to marked limitation of physical activity. Control patients (n ¼ 131) received usual care, consisting of regular checkups at an outpatient clinic. Intervention group patients (n ¼ 186) received usual care and participated in a 6-week self-management group programme. Favourable effects on walking for exercise and other physical activities such as aerobic, stretching, and strength exercises, sports, and gardening were reported in the intervention group immediately after completion of the programme. The effect of the programme on other physical activities extended to 6 months of follow-up. No favourable effects were found for the other outcomes. ConclusionThe CDSMP significantly improved physical activity among CHF patients for up to 6 months after the end of the programme; however, it did not affect other health behaviour outcomes or healthcare utilization. ----------------------------------------------------------------------------------------------------------------------------------------------------------- KeywordsHeart failure † Randomized, controlled trial † Self-management † Health behaviour † Healthcare utilization IntroductionCongestive heart failure (CHF) is a major public health concern, due to ageing of the population the prevalence and incidence of CHF is likely to increase dramatically over the coming years, imposing an enormous burden on society in terms of mortality, morbidity, and associated healthcare costs. 1 Efficient management of CHF therefore remains a challenge for both patients and healthcare providers. Congestive heart failure patients face severe symptoms such as fatigue, shortness of breath, and exercise intolerance due to cardiac dysfunction. This substantially affects their physical functioning, quality of life, and mortality rates. 2,3 Furthermore, patients need to make considerable adjustments to their life style to prevent CHF exacerbations by, for example, adhering to a dietary sodium and fluid restriction, taking prescribed medications, and staying physically active. For this reason, patients are encouraged to take responsibility for the day-to-day management of their disease as patients' own self-care abilities are crucial in CHF management. 4,5 Unfortunately, many patients fail to adhere to the complex treatment regimen. A downward spiral of functional deterioration and non-compliance may then lead to increased healthcare utilization and a progressive decline in the ...

Background: Congestive heart failure (CHF) has a substantial impact on care utilisation and quality of life. It is crucial for patients to cope with CHF adequately, if they are to live an acceptable life. Selfmanagement may play an important role in this regard. Previous studies have shown the effectiveness of the 'Chronic Disease Self-Management Program' (CDSMP), a group-based cognitive behavioural programme for patients with various chronic conditions. However, the programme's effectiveness has not yet been studied specifically among CHF patients. This paper presents the design of a randomised controlled trial to evaluate the effects of the CDSMP on psychosocial attributes, health behaviour, quality of life, and health care utilisation of CHF patients.

No abstract

No 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.

No abstract

People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website.• The final author version and the galley proof are versions of the publication after peer review.• The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal.If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement: