Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure

Abstract

Background The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. Objective The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I-III HF. Our secondary purpose was to explore participants’ subjective perceptions of the intervention. Methods This study used a randomized, 2 group design. Fifty people were enrolled for 9 months and tested at 4 time points—baseline; following a 3-month education-support intervention; at 6 months, following 3-months of telephone/email support; and 9 months, following a 3-month period of no contact. Advanced practice registered nurses (APRNs) delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention’s effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. Results The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%), and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy and quality of life (Kansas City Cardiomyopathy Questionnaire-KCCQ); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire-MIA); self-care knowledge (HF Knowledge Test-HFKT); and self-care (Self-Care in Heart Failure Index—SCHFI). Participants in both groups improved in depressive scores (Geriatric Depression Scale-GDS). Conclusions An in-home intervention delivered by APRNs was successful in several health status and self-care outcomes, including self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.

Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa

“…Therefore, individualized education focused on disease self-management improves individuals' QoL (40) . This type of monitoring has good results due to low operational costs and easiness obtaining of information (36)(37)(38)(39)(40)(41) .…”

“…Early detection of signs and symptoms of HF decompensation can reduce the number of hospitalizations and their length, as well as improve these patients' QoL (13) . Regarding instructions on health practices, nurses stand out for promoting significant improvements in outcomes, such as functional status, self-efficacy, memory, knowledge of disease and QoL (38) . In this category, in the study that proved effective in improving QoL of people with HF, there was telephone follow-up that involved aspects of self-maintenance and selfmanagement, in addition to practical supervision of skills for self-monitoring and self-management by a nurse (22) .…”

Impacto do monitoramento telefônico em pacientes com insuficiência cardíaca: ensaio clínico randomizado

“…The evaluation of metamemory in studies that have HF knowledge as their outcome seems to offer promising results that should be better elucidated in future research. (19) Despite different outcomes in the monitoring of HF patients, as in the previously mentioned studies, the number and frequency of telephone calls and the teaching-learning strategies used must be considered. The studies do not usually provide detail about how the telephonic-based approach occurs, considering all recommendations for improving knowledge and self-care.…”

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…Content TPE Interventions for Self-Management was similar to the study by Krumholz et al, 148 and the intervention group had significantly fewer readmission days and deaths, along with better compliance with self-management behaviors. Clark et al 150 studied the effect of eight 1-to 1.5-hour education sessions delivered in the home by advanced practice nurses over a 3-month period, combined with written education and follow-up phone calls, on health status and self-management outcomes. The intervention group showed significant improvements in functional status, HF knowledge and self-management, quality of life, memory, and self-efficacy.…”