The effect of education and counselling on knowledge, attitudes and beliefs about responses to acute myocardial infarction symptoms.

The time that elapses from the onset of symptoms of acute myocardial infarction (AMI) to treatment has a significant effect on mortality and morbidity. This study reports the effectiveness of an education and counselling intervention on knowledge, attitudes and beliefs about AMI symptoms and the appropriate response to symptoms. The intervention was tested in a randomised controlled trial of 200 people with a history of coronary heart disease (CHD). The groups were equivalent at baseline on study outcomes, clinical history and sociodemographic characteristics with the exception of more women in the intervention group (38% vs. 24%). The results of repeated measures ANOVA showed that the intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms that was sustained to 12 months (p=0.02). There were no differences between groups' attitudes and beliefs over time. It is concluded that a short individual teaching and counselling intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms in people at risk of AMI sustained to 12 months.

Development and testing of the European Heart Failure Self-Care Behaviour Scale.

BACKGROUND: Improvement of self-care behaviour is an aim of several non-pharmacological nurse-led management programmes for patients with heart failure. These programmes are often evaluated based on their effects on readmission, costs and quality of life. It is, however, also important to know how patients changed their self-care behaviour as a result of such a programme. Therefore a comprehensive, reliable and valid measure of the self-care behaviour of HF patients is needed. OBJECTIVES: To develop a scale measuring the behaviour that heart failure patients perform to maintain life, healthy functioning, and well-being. METHOD: The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed in three phases: (1) concept analysis and first construction; (2) revision of items and response and scoring format; and (3) testing of the new scale for validity and reliability. RESULTS: The European Heart Failure Self-Care Behaviour Scale is a 12-item, self-administered questionnaire that covers items concerning self-care behaviour of patients with heart failure. Face-validity and concurrent validity was established and the internal consistency of the scale was tested using pooled data of 442 patients from two centres in Sweden, three in the Netherlands and one in Italy. Cronbachs's alpha was 0.81. CONCLUSION: The instrument is a valid, reliable and practical scale to measure the self-reported self-care behaviour of heart failure patients. It is ready to use by investigators evaluating the outcome of heart failure management programmes that target changes in patients' self-care practices.

Decisive situations influencing spouses' support of patients with heart failure: a critical incident technique analysis.

OBJECTIVE: The aim of this study was to describe decisive situations experienced by spouses of patients with heart failure that could potentially affect their ability to provide social support to the patient. METHODS: A qualitative descriptive design with a critical incident technique was used. Twenty-three informants, 15 women and 8 men, who were spouses of patients with severe heart failure were strategically chosen to ensure maximal variation in sociodemographic data and experiences as a spouse. RESULTS: Decisive situations influenced the experience of spouses of patients with heart failure in a manner that was either positive (involvement with others) or negative (feeling like an outsider). When spouses were given attention and treated like persons of value, they experienced involvement with others. In these cases, spouses had someone to turn to and were included in the physical care. In contrast, when spouses were kept at a distance by the patient, were socially isolated, and received insufficient support from children, friends, and health care professionals, they experienced feeling like an outsider. CONCLUSIONS: By identifying spouses' experiences, health care professionals can assess which kind of specific interventions should be used to improve the life situation of the patient with heart failure and his or her spouse.

Educational needs of patients with advanced heart failure and their caregivers.

At the time of initial transplant evaluation, we evaluated the information and counseling needs of 82 outpatients with advanced heart failure and compared them with the needs of 74 of their caregivers. Both groups answered a 23-item questionnaire, which used a 5-point Likert scale to assess needs across 6 sub-scales specific to heart failure and the process of determining transplant eligibility. The 5 most important learning needs of patients and caregivers were similar, and we found significant differences only in the groups' responses to 3 individual questions. We conclude that nurses can meet the needs of patients and their caregivers by providing honest explanations, focusing on enhanced quality of life issues, and giving information for dealing with an emergency.

Relationship between psychosocial variables and compliance in patients with heart failure.

OBJECTIVE: The purpose of this study was to describe the socio-demographic, psychosocial, and social support variables that predict compliance to treatment regimens in HF patients. DESIGN AND SETTING: Semistructured interviews were conducted on 82 patients at an outpatient heart failure clinic to gather data related to compliance behaviors. Five standardized instruments were used to gather data on patients' psychosocial health status and perceived social support. RESULTS: The overall compliance rate was 85.13 (10.01%). Higher levels of compliance (> 90%) were noted for follow-up appointments, medications, smoking, and alcohol cessation. Poor compliance was observed with dietary and exercise recommendations (71% and 53%, respectively). In a multivariate model, higher education, higher mental and physical health status and neuroticism independently contributed to 24% of the variance in overall compliance. CONCLUSION: The study supports that HF patients had poor compliance with dietary and exercise regimens. Since following a dietary and exercise regimen has been demonstrated to reduce morbidity in this population, strategies to increase compliance should be rigorously pursued [corrected].

Predictors of isotonic exercise in patients with heart failure.

PURPOSE: Study aims were to determine the predictors of isotonic resistance exercise performance in patients with advanced heart failure and to compare the preexercise values of patients who experienced a negative physiologic response to resistance exercise with those who had minimal or no response. METHODS: A correlational design was used. After pharmacologic left ventricular unloading therapy using a pulmonary artery catheter, 34 patients with advanced heart failure performed graduated isotonic weight-lifting exercises. Measurements were made of hemodynamics and rating of perceived exertion after each test. RESULTS: The following variables, measured at baseline, were significantly correlated with the amount of weight patients were able to lift: rating of perceived exertion (RPE; r = -0.42, P = 0.014); diastolic blood pressure (DBP; r = 0.49, P = 0.03); systolic blood pressure (SBP; r = 0.40, P = 0.017); pulmonary capillary wedge pressure (PCWP; r = 0.39, P = 0.026); and right atrial pressure (RAP; r = 0.35, P = 0.041). Multiple regression analysis, using a stepwise procedure, showed that 47% of the variance in exercise performance was explained by DBP, RPE, and PCWP. There were no significant differences in baseline hemodynamics, ejection fraction, or age between the group of patients who had a negative hemodynamic response at peak exercise and the group of patients who had minimal or no response. CONCLUSIONS: Resting PCWP, DBP, and RPE can provide important information to help clinicians predict isotonic resistance exercise performance in patients with advanced heart failure. However, those patients who have a negative response to this type of exercise cannot be distinguished at baseline by clinical characteristics or age.

Role of spirituality in adjustment of patients with advanced heart failure.

Heart failure is a chronic and progressive disease often characterized by severe symptoms, frequent hospitalization, and poor prognosis. It may threaten the individual's sense of self and lead to questions related to spirituality. The purpose of this qualitative, phenomenologic study was to describe the role of spirituality in the adjustment of patients to advanced heart failure. Purposive sampling of all patients who presented to two university-affiliated, outpatient heart failure clinics was used. Eighty-seven patients were interviewed using a semistructured questionnaire. Data were subjected to content analysis and thematic coding. Patients described a three-step process where spirituality contributed to their adjustment to advanced heart failure: development of regret regarding past behaviors and lifestyles; the search for meaning within the present experience of heart failure; and the search for hope for the future and reclaiming of optimism. Assessment and interventions that include a spiritual dimension can facilitate the adjustment of patients to advanced heart failure.

Gender differences in health perceptions and meaning in persons living with heart failure.

OBJECTIVE: The goal of this study was to determine whether gender differences exist in health perceptions, psychosocial adjustment to illness, and concerns related to illness in patients with heart failure (HF). DESIGN: Thirty-two patients (50% women) from a single outpatient HF clinic were asked to complete standardized tools to assess health perceptions and psychosocial adjustment to illness. Open-ended questions were used to obtain data on concerns related to HF. RESULTS: The women had higher health perceptions than men did; they also demonstrated better psychosocial adjustment to illness. The qualitative data further suggest that women ascribed more positive meanings to their illness than men did. CONCLUSION: The current study underscored the importance of gender differences in health perceptions related to HF. Patient teaching and counseling can be tailored to address the gender-specific concerns of men and women suffering with this condition to improve patient outcomes.

Quality of life in patients with heart failure: do gender differences exist?

OBJECTIVE: The purpose of this study was to evaluate gender differences in quality of life (QOL) in a large sample of age-matched and ejection fraction (EF)-matched patients with heart failure. DESIGN: Matched comparisons of secondary data were used. SETTING: The setting consisted of multicenter Studies of Left Ventricular Dysfunction trials. SAMPLE: The sample included 1382 patients (691 men and 691 women) who were age-matched and EF-matched. OUTCOME MEASURES: Global QOL and the QOL dimensions of physical function, emotional distress, social health, and general health were measured using the Ladder of Life, items from the Profile of Mood States Inventory, the Functional Status Questionnaire, the beta-Blocker Heart Attack Trial instrument, and an item from the RAND Medical Outcomes Study instrument. RESULTS: Women had significantly worse general life satisfaction, physical function, and social and general health scores than men. There were no significant differences found between gender groups for current life situation or emotional distress. After controlling for New York Heart Association classification, women still had significantly worse ratings for intermediate activities of daily living (a sub-dimension of physical functioning) and social activity. CONCLUSIONS: Despite controlling for age, EF, and New York Heart Association classification, women had worse QOL ratings than did men for intermediate activities of daily living and social activity. Research should focus on identifying why differences exist and developing measures to improve QOL, particularly physical functioning, in women with heart failure.

Effect of a collaborative weaning plan on patient outcome in the critical care setting.

OBJECTIVE: The process of weaning from mechanical ventilation can be complex, requiring collaborative care planning by members of the healthcare team. Improved outcomes have been demonstrated to result from collaborative decision-making processes (e.g., when ventilator teams were utilized). The purpose of this study was to evaluate the effect of a collaborative weaning plan (CWP) on length of time on mechanical ventilation, length of stay in the intensive care unit (ICU), and cost. DESIGN: A new, collaborative weaning plan in the form of a weaning board and flowsheet was introduced into a medical intensive care unit (MICU) setting. A pre- and post-quasi-experimental design using historical controls was used to test the hypotheses. Attempts to control for the effects of history were made by collecting data related to patient, staffing, and organizational variables that could independently effect outcome. SETTING: MICU in a west coast teaching hospital. PATIENTS: Critically ill patients receiving mechanical ventilation for 3 days or greater. INTERVENTION: Implementation of a collaborative weaning plan. MEASUREMENTS: Outcomes studied included length of stay in the MICU, length of time patients were mechanically ventilated in the MICU, cost per MICU stay, and the incidence of complications (e.g., reventilation, readmission to the ICU, and mortality rate). MAIN RESULTS: The CWP decreased length of stay in the MICU by 3.6 days (p =.03) and length of ventilator time by 2.7 days (p =.06). There were no significant differences between groups related to cost or incidence of complications. CONCLUSIONS: These results support the usefulness of collaborative structures (such as weaning boards/flowsheets) in decreasing ICU length of stay.

Usefulness of a history of tobacco and alcohol use in predicting multiple heart failure readmissions among veterans.

Multiple hospital readmissions for heart failure (HF) are progressively increasing and may be related to continued tobacco and alcohol use. To study this relation, we conducted a retrospective chart audit of all veterans discharged with HF at a large Veterans Administration (VA) facility from 1997 to 1998. Using a multivariate logistic regression model, the smoking and alcohol use of patients who required > 1 HF admission within 1 year were compared with those who did not. Demographic, clinical, and psychosocial variables were also included in the model. Of 753 patients admitted with HF during the review period (mean age 69.1 years, 99% men), 220 patients (29.2%) were readmitted to the hospital at least once (range 1 to 8 readmissions, mean 1.79 +/- 0.27) after the index admission. In a multivariate analysis, current smoking (odds ratio [OR] 1.82; confidence interval [CI] 1.17 to 2.82) and current alcohol use (OR 5.92; CI 3.83 to 9.13) were independent predictors of readmissions. Other predictors included living alone (OR 2.09; CI 1.42 to 3.09), HF associated with ischemic etiology (OR 3.99; CI 2.58 to 6.18), higher New York Heart Association class (OR 2.57; CI 1.86 to 3.55), and care provided by a primary care physician compared with a cardiologist (OR 2.41; CI 1.57 to 3.67). This study confirms that noncompliance to smoking and alcohol restrictions, which are amenable to change, dramatically increases the risk for multiple hospital readmissions among patients with HF. Consequently, evaluation of noncompliance to smoking and alcohol consumption with targeted interventions in this population may be a key component for the reduction of multiple hospital readmissions.