Effect of nurse-led hospital-to-home transitional care interventions on mortality and psychosocial outcomes in adults with heart failure: a meta-analysis

Effectiveness of palliative care interventions on patient-reported outcomes and all-cause mortality in community-dwelling adults with heart failure: A systematic review and meta-analysis

BACKGROUND

Current evidence that supports palliative care interventions predominantly focuses on individuals with cancer or hospitalized patients. However, the effectiveness of palliative care on patient-reported outcomes and mortality in community-dwelling adults with heart failure has not been evaluated.

OBJECTIVE

We aimed to evaluate the effectiveness of palliative care interventions on patient-reported outcomes and all-cause mortality in community-dwelling adults with heart failure.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

METHODS

MEDLINE, Embase, Cochrane Library, and CINAHL databases were searched from inception to October 2023. Randomized controlled trials were considered if they compared palliative care interventions with usual care, attention control, or waiting-list control primarily in a community-dwelling heart failure patient population. The primary outcome was patient-reported generic health-related or heart failure-specific quality of life. Secondary outcomes were patient-reported symptom burden, psychological health (anxiety and depression), spiritual well-being, and all-cause mortality. Two independent reviewers screened the retrieved articles and extracted data from the included studies. A random-effects meta-analysis was performed to pool the data, followed by sensitivity analysis, subgroup analysis, and meta-regression. All analyses were performed using R version 4.2.2.

RESULTS

Eleven eligible studies were included in this review with a total of 1535 patients. Compared to usual care, palliative care interventions demonstrated statistically significant effects on improving generic health-related quality of life (SMD, 0.30 [95 % CI, 0.12 to 0.48]) and heart failure-specific quality of life (SMD, 0.17 [95 % CI, 0.03 to 0.31]). Palliative care interventions also reduced anxiety (SMD, -0.22 [95 % CI, -0.40 to -0.05]) and depression (SMD, -0.18 [95 % CI, -0.33 to -0.03]), and enhanced spiritual well-being (SMD, 0.43 [95 % CI, 0.05 to 0.81]), without adversely affecting all-cause mortality (RR, 1.00 [95 % CI, 0.76 to 1.33]). Yet, the interventions had no significant effects on symptom burden (SMD, -0.09 [95 % CI, -0.40 to 0.21]). The certainty of evidence across the outcomes ranged from very low to moderate based on the GRADE approach.

CONCLUSIONS

Palliative care interventions are beneficial for community-dwelling adults with heart failure in that the interventions improved patient-reported quality of life, psychological health, and spiritual well-being, and importantly, did not lead to higher mortality rates. Findings of this review support the implementation of palliative care for adults with heart failure in community settings.

REGISTRATION

CRD42023482495.

Nurse-led self-care interventions for older adults with multiple chronic conditions: A protocol for a systematic review and network meta-analysis

The importance of self-care interventions is progressively recognized, marked by a rapidly aging population that results in growing demands on costly tertiary and institutional care services, placing substantial pressure on health and social care systems. Against this background, in this study, we will provide evidence for the impact of self-care interventions on health-related quality of life by focusing on interventions led by nurses who can employ integrated approaches. Several databases, including Ovid MEDLINE, Cochrane, CINAHL, Embase, and PubMed, will be searched along with gray literature to prevent biased results. There will be no time restrictions, and all literature with English abstracts will be included. Using the Template for Intervention Description and Replication framework, we will evaluate intervention characteristics. The primary outcome will be health-related quality of life, and the secondary outcomes will be symptom burden, physical function, and cost-effectiveness. Pairwise and network meta-analyses will be performed, and network geometry and the surface under the cumulative ranking curve will be used to determine which type of nurse-led self-care intervention is best for health-related quality of life for older adults with multiple chronic conditions. We will secure study quality through PRISMA, AMSTAR 2, RoB 2.0, and the GRADE checklist. To ensure the quality of network meta-analysis, similarity will be checked based on the PICO framework. The consistency of the network meta-analysis results will be checked to ensure transitivity by using the Bayesian hierarchical framework. The study protocol is registered with PROSPERO (CRD42022365467).

Developing Multidisciplinary Management of Heart Failure in the Super-Aging Society of Japan

The Japanese population is rapidly aging because of its long life expectancy and low birth rate; additionally, the number of patients with heart failure (HF) is increasing to the extent that HF is now considered a pandemic. According to a recent HF registry study, Japanese patients with HF have both medical and care-related problems. Although hospitalization is used to provide medical services, and institutionalization is used to provide care for frail older adults, it can be difficult to distinguish between them. In this context, multidisciplinary management of HF has become increasingly important in preventing hospital readmissions and maintaining a patient's quality of life. Academia has promoted an increase in the number of certified HF nurses and educators. Researchers have issued numerous guidelines or statements on topics such as cardiac rehabilitation, nutrition, and palliative care, in addition to the diagnosis and treatment of acute and chronic HF. Moreover, the Japanese government has created incentives through various medical and long-term care systems adjustments to increase collaboration between these two fields. This review summarizes current epidemiological registries that focus not only on medical but also care-related problems and the 10 years of multidisciplinary management experience in Japanese medical and long-term care systems.

Transitional Care in Patients with Heart Failure: A Concept Analysis Using Rogers' Evolutionary Approach

Objective

The purpose of this study was to clarify the concept of transitional care in patients with heart failure.

Background

Transitional care is increasingly being applied in patients with heart failure, but the concept of transitional care in heart failure patients is not uniform and confused with other definitions, which limits further research and practice on transitional care for these patients.

Design

Rodgers' evolutionary concept analysis.

Methods

A comprehensive literature search was conducted using the PUBMED, EMBASE, EBSCO, Chinese Biological Medicine (CBM), CNKI, and WANFANG databases (up to January 26, 2023). We used Rodgers' evolutionary concept analysis method to identify related concepts, attributes, antecedents, and consequences of transitional care in patients with heart failure.

Results

A total of 33 articles were included. The following attributes belonging to transitional care in patients with heart failure were extracted from the literature: self-care, multidisciplinary collaboration, and information transmission. The antecedents were patients' health status, the health literacy of patients and caregivers, the role functions of the main implementer and social and medical resources. Consequences were separated into two categories: patient-centered health outcomes (all-cause mortality, health-related quality of life, discharge preparedness, self-care behaviors, satisfaction of patients) and healthcare utilization outcomes (hospital readmission, length of hospital stay, emergency department visits).

Conclusion

This study found that transitional care in heart failure patients is a systemic care process during a vulnerable period that improves patient self-management and coordination between hospital resources and social support systems for continuous management to promote smooth patient transitions between different locations. This concept analysis will inform healthcare providers in designing evidence-based interventions and quality improvement strategies to ensure that transition processes lead to desired outcomes. In addition, this study will also be helpful for developing specific assessment tools to identify patients with HF who need transitional care.

Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study

Heart failure (HF) patients should be systematically educated before discharge on how to manage with standard written materials for patient self-management. However, because of the absence of readily available written materials to reinforce their learned knowledge, patients with HF feel inadequately informed in terms of the discharge information provided to them. This study aimed to develop core content to prepare patients with HF for transition from hospital to home care. The content was validated by expert panelists using Delphi methods. Nineteen draft items based on literature review were developed. We established a consensus on four core sections, including 47 categories and 128 subcategories through the Delphi survey: (1) understanding HF (five categories and 23 subcategories), (2) HF medication (19 categories and 45 subcategories), (3) HF management (20 categories and 47 subcategories), and (4) HF diary (three categories and 13 subcategories). Each section provided easy-to-understand educational contents using cartoon images and large or bold letters for older patients with HF. The developed core HF educational contents showed high consensus between the experts, along with clinical validity. The contents can be used as an educational booklet for both planning discharge education of patients with HF and for post-discharge management when transitioning from hospital to home. Based on this study, a booklet series for HF patients was first registered at the National Library of Korea. Future research should focus on delivering the core content to patients with HF in convenient and accessible format through various media.