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 ...

No abstract

No abstract

No abstract

No abstract

No abstract

instruments namely 12 generic, seven disease-specific and 13 domain-specific Hr-QoL questionnaires. Barely half of the analysed studies conceptualised Hr-QoL, and extensive differences in the conceptions of Hr-QoL also existed. Three main objectives in the used Hr-QoL instruments were found; to assess and describe Hr-QoL in CHF, to describe the impact of interventions on Hr-QoL in CHF, and to examine relationsypredictors of Hr-QoL in CHF. In approximately half of the analysed studies a single generic instrument was used to evaluate the main outcome. In studies evaluating the impact of interventions, the foremost disease-specific questionnaires were used both as a single instrument as well as together with a generic instrument. Both generic and disease-specific instruments were used to examine relations and predictors of Hr-QoL in CHF. Another option consists of a battery of mixed Hr-QoL domainspecific instruments to cover the different domains of Hr-QoL. Studies using this approach were spread among the three main objectives. In some of the articles using a battery approach, disease-specific instruments were mixed together with both generic andyor disease-specific instruments. The many instruments available, the different aspects of how to implement them, the absence of and the divergent conceptions about Hr-QoL may cause difficulties in the interpretation and understanding of the results. Implications: The focus for future nursing research in patients with CHF should be on developing guidelines on how to measure Hr-QoL and the refinement of existing instruments, instead of developing new ones.