Impact of advances in therapy for heart failure on secular trends in mortality

Evidence to practice: pre-post-implementation study of a patient/provider resource for self-management with heart failure

Background  Evidence-based recommendations for heart failure self-management are contained in quality clinical practice guidelines. To implement these in practice requires additional translation. Partners in Care for Congestive Heart Failure (PCCHF) is a set of resource materials developed to encourage heart failure patients and their families to assume greater responsibility and to participate in daily decision-making related to their illness experience by enhancing their self-assessment and self-management skills. The study objectives were to evaluate its use, acceptability and relevance of this approach by heart failure patients, nurses and policy-makers. Methods  A pre-post study was conducted across 10 rural-urban, acute and community care sites within three Canadian provinces and one US state. Patients' health-related quality of life was assessed with Minnesota Living with Heart Failure Questionnaire and Medical Outcomes Short Form before and 6 weeks after using the PCCHF program. Nurses completed a survey and participated in focus groups. Policy-makers were interviewed before and post implementation. Results  Baseline and 6-week measures were completed by 239 patients. Health-related quality of life measures revealed statistically significant improvement after 6 weeks. Thirty-three nurses and 19 policy-makers participated in interviews post implementation. Most patients, nurses and policy-makers found the resource acceptable and relevant to support information needs. Conclusion  The PCCHF program positively benefited both patients and clinical staff. The evidence-based teaching materials were considered a useful resource for self-management with heart failure. Time constraints and high staff turnover underline the need for resources like PCCHF to assist in patient-oriented heart failure self-management. Copyright for PCCHF has been transferred to the Canadian Heart and Stroke Foundation for widespread dissemination.

Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition

BACKGROUND

The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses.

METHODS

A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge.

RESULTS

At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 +/- 19.1 SD) than among the Usual Care patients (37.5 +/- 20.3 SD; P = 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P = 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (chi2 = 4.86, df 1, P = 0.03).

CONCLUSIONS

There were significant improvements in health-related quality of life (HRQL) associated with Transitional Care and less use of emergency rooms.