What kind of patient education and self-care support do patients with heart failure receive, and by whom? Implementation of the ESC guidelines for heart failure in three European regions

Cross-Cultural Adaption and Psychometric Evaluation of Chinese Version of the Caregiver Contribution to Self-Care of Heart Failure Index

To translate and adapt the English version of the Caregiver Contributions to Self-Care of Heart Failure Index (CC-SCHFI) to Chinese, and further to investigate the psychometric properties of the Chinese version of CC-SCHFI in a cohort of caregivers of people with heart failure. CC-SCHFI translation and cross-cultural adaption were performed. 240 caregivers were recruited to complete the instrument. The internal construct reliability was evaluated by Cronbach's α and item-to-total correlations. The concurrent validity was tested by using the CACHS which also measures caregivers' contribution to HF self-care. Psychometric analysis was performed with confirmatory factor analysis (CFA). We evaluated 4-factor structure for caregiver contribution to self-care maintenance scale, 1-factor structure for caregiver contribution to self-care management scale and 2-factor structure for confidence in contributing to self-care scale. All the subjects successfully completed the interviews in an average of 12.3 ± 3.2 min. The internal consistency reliability analysis of the CC-SCHFI showed Cronbach α of 0.83. All items showed adequate discrimination, with the item-total correlation coefficient of greater than 0.4. The scores of CC-SCHFI scales were significantly correlated with the CACHS scale scores. The correlation coefficients ranged from 0.341 to 0.765, indicating acceptable concurrent validity. For CFA, all factor loadings were significant at > 0.30 and generally medium to high. The simplified Chinese version of CC-SCHFI is a psychometrically reliable instrument with empirically supported validity, which can be applied to clinical evaluation of the contribution of caregivers to HF self-care. Compared with CACHS, CC-SCHFI can be more easily completed and simultaneously maintains acceptable concurrent validity. Further studies are warranted to investigate the combined use of these two instruments among other populations.

Insights into clinical practice: A national survey on fluid intake management in heart failure

AIMS

Due to insufficient evidence and a lack of cohesive guidelines, the management and use of fluid restriction in patients with heart failure (HF) may vary among healthcare professionals. However, the extent of this variation is unknown. The aim of this study was to describe physicians' and registered nurses' (RN) clinical practice regarding fluid intake and fluid restriction in adult patients with HF.

METHODS AND RESULTS

Physicians and RNs treating patients with HF at 75 hospitals across all healthcare regions in Sweden were invited to answer a web-based survey regarding management on fluid intake and fluid restriction. Data were analysed with descriptive statistics and chi-square test. A total of 646 physicians and RNs across 45 hospitals in Sweden completed the survey. Significant differences in recommendations and management were found in relation to professional role, care setting and work experience. Overall, 93.8% recommend fluid restriction for all or some patients with HF. RNs recommend fluid restriction for all patients with HF to a significantly higher extent compared with physicians (34.5% vs. 14.9%; P < 0.001). Additionally, 49.2% believe that fluid restriction is an effective treatment strategy to prevent congestion, and 29.3% recommend fluid restriction routinely. One-third lacked knowledge of existing local guidelines regarding fluid restriction.

CONCLUSIONS

This study shows that there are differences in clinical practice regarding healthcare professionals' recommendations on fluid intake and fluid restriction. These differences may result in patients with HF receiving varied and inconsistent care. Recommendations were primarily based on each healthcare professional's individual opinion rather than on evidence and guidelines.

Examining the clinical role and educational preparation of heart failure nurses across Europe. A survey of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP) of the ESC

AIMS

To describe the clinical practice and educational preparation of heart failure (HF) nurses across Europe and determine the key differences between countries.

METHODS AND RESULTS

A survey tool was developed, in English, by the Heart Failure Association Patient Care committee of the European Society of Cardiology (ESC). It was translated into eight languages, before electronically disseminated by nurse ambassadors, presidents of HF national societies and through social media. A total of 837 nurses involved in the daily care of patients with HF from 15 countries completed the survey. Most nurses, 78% (n = 395) worked within a hospital outpatient setting, and 51% (n = 431) had access to a specialized HF multidisciplinary team. Nurses performed a range of activities including patient education to promote self-care, virtual and in-person symptom monitoring. A third had more than 5-year experience in cardiac care and 22% (n = 182) prescribed HF medications. There was a significant correlation between HF nurses that prescribed HF medications and access to a specialist multidisciplinary team (p = 0.04). A small number of nurses, mainly from Belgium, supported invasive monitoring (n = 68, 8%) with 14% (n = 120) of mostly Danish nurses supporting exercise programmes. The majority of nurses surveyed were committed to further academic professional development, with 41% (n = 343) having completed a HF course.

CONCLUSION

The role of the HF nurse varies across Europe, however involvement in patient education, symptom monitoring and follow-up remain core to their practice. In specific activities including the prescribing of HF medications and involvement in invasive monitoring, practice has advanced with collaboration in the multidisciplinary team. Consequently, harmonization of education, training and career pathways are required to standardize HF care aligned with expert guidelines across Europe.

[The role of complex patient education program in heart failure care]

Bevezetés: Az Európai Kardiológus Társaság 2021-es Szívelégtelenség Irányelvének tükrében a szívelégtelenségben szenvedő betegek gondozásának kulcsfontosságú része a betegoktatás, többek között az öngondoskodás elemeinek megtanítása, a sürgősségi állapotok felismerésével kapcsolatos ismeretek oktatása. Célkitűzés: Az Intézetünkben zajló komplex szívelégtelenség-betegoktatási program hatásának felmérése a szívelégtelenséggel, öngondoskodással kapcsolatos ismeretekre, illetve azok tartós fennmaradására. Módszer: Az Intézetünk Szívelégtelenség Részlegén szívelégtelenség-tünetegyüttes miatt 2023. 06. 01-jétől hospitalizált betegek körében strukturált betegoktatási programot folytattunk. A betegek és hozzátartozóik egy interaktív előadáson vettek részt azzal a céllal, hogy elsajátítsák a szívelégtelenség fő jellemzőivel, az öngondoskodással, a sürgősségi állapotok felismerésével kapcsolatos ismereteket. Az oktatást megelőzően, közvetlenül az oktatás után, illetve 3 és 6 hónap múlva 11 kérdésből álló, egyszerű választásos kérdőívvel mértük fel a betegek ismereteit. Továbbá vizsgáltuk az öngondoskodással kapcsolatos napi teendők gyakorlásának változását. Eredmények: Vizsgálatunkban a betegoktatási programban részt vevő első 87, szívelégtelenség-tünetegyüttes miatt hospitalizált, konszekutív beteg adatait elemeztük. 76%-uk férfi, mediánéletkoruk 56 (45–64) év volt. Szívelégtelenség miatt korábban 45%-ukat hospitalizálták. Az oktatás hatására a betegek ismeretei szignifikánsan javultak a kérdőíven elért összpontszám alapján (9 [8–10] vs. 11 [11-11] pont, p<0,001; oktatás előtt vs. után). Az ismeretek tartósan, stabilan fennmaradtak (p<0,001) a 3 (9 [8–10] vs. 11 [10–11] pont; oktatás előtt vs. után 3 hónappal) és a 6 hónapos (9 [8–10] vs. 11 [10–11] pont; oktatás előtt vs. után 6 hónappal) utánkövetés során. Az öngondoskodással kapcsolatos napi teendők (vérnyomás-, pulzus-, testsúlymérés, a folyadékbevitelre való odafigyelés) gyakorlása az önbevallás alapján a betegoktatási program hatására szignifikánsan (p<0,001) javult. Következtetés: Eredményeink alapján a szívelégtelenséggel foglalkozó nővér bevonásával végzett strukturált betegoktatási program javítja a betegek szívelégtelenséggel, öngondoskodással kapcsolatos ismereteit, melyek felmérésünk alapján tartósan megmaradtak. Továbbá a betegoktatási program hatására az öngondoskodással kapcsolatos napi teendők gyakorlása jelentősen javult. Mindezek a szívelégtelenség miatti hospitalizáció során végzett betegoktatás jelentőségére hívják fel a figyelmet. Orv Hetil. 2024; 165(37): 1461–1471.

Exploring heart failure nurse practitioner outcome measures: a scoping review

AIMS

Clinical guidelines recommend people with heart failure are managed within a multidisciplinary team to receive optimal evidence-based management of the syndrome. There is increasing evidence that Nurse Practitioners (NP) in heart failure demonstrate positive patient outcomes. However, their roles as key stakeholders in a multidisciplinary heart failure team are not clearly defined. The aim of the review was to explore the literature related to NP-sensitive outcomes in heart failure.

METHODS AND RESULTS

A scoping review was conducted according to accepted guidelines using the Joanna Briggs Institute framework for conducting a scoping review, to identify the literature that related to NP-sensitive outcomes in heart failure management. Sixteen texts were selected for data extraction and analysis. The most common outcome measures reported were readmission rates, self-care measurement scales, functional status scores, quality of life measurements, and medication optimization outcomes. No two studies collected or reported on the same outcome measurements.

CONCLUSION

This review highlights that the reporting of heart failure (HF) NP outcome indicators was inconsistent and disparate across the literature. The outcome measures reported were not exclusive to NP interventions. Nurse Practitioner roles are not clearly defined, and resulting outcomes from care are difficult to characterize. Standardized NP-specific outcome measures would serve to highlight the effectiveness of the role in a multidisciplinary HF team.

Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention

OBJECTIVE

The current study delves into the impact of heart failure education intervention on improving therapeutic outcomes for heart failure (HF) patients with reduced nonvalvular ejection fraction.

METHODS

There involved a total of 60 HF patients with non-valvular ejection fraction reduction who met the inclusion requirements. Patients enrolled were randomly distributed into an observation group and a control group. The observation group received heart failure education intervention, while the control group received conventional intervention. The therapeutic effect, changes in physical indicators, cardiac function indicators, coagulation function, self-management scale scores, and the incidence of adverse cardiovascular events were meticulously evaluated.

RESULTS

The total effective proportion in the observation group was 96.67%, which was significantly higher than the control group's proportion of 76.67% (p < .05). After treatment, several parameters in the observation group showed significant improvements compared to the control group: hs-CRP, IL-6, LVEDV value, LVESV value, PT value, APTT value, and TT value were all evidently lower in the observation group. Additionally, the cardiac index, LVEF value, and heart failure self-management scale fraction were significantly higher in the observation group compared to the control group (p < .05). Furthermore, the incidence of adverse cardiovascular events in the observation group was only 6.67%, which was significantly lower than the control group's incidence of 20.00% (p < .05).

CONCLUSION

Heart failure education intervention demonstrates effectiveness in improving the therapeutic outcomes for HF patients and reduced nonvalvular ejection fraction. Additionally, it enhances patients' self-management abilities. Given these positive results, it is highly recommended to promote and implement HF education intervention in clinical practice.

Heart Failure with Preserved Ejection Fraction: How to Deal with This Chameleon

Heart failure with preserved ejection fraction (HFpEF) is characterized by a notable heterogeneity in both phenotypic and pathophysiological features, with a growing incidence due to the increase in median age and comorbidities such as obesity, arterial hypertension, and cardiometabolic disease. In recent decades, the development of new pharmacological and non-pharmacological options has significantly impacted outcomes, improving clinical status and reducing mortality. Moreover, a more personalized and accurate therapeutic management has been demonstrated to enhance the quality of life, diminish hospitalizations, and improve overall survival. Therefore, assessing the peculiarities of patients with HFpEF is crucial in order to obtain a better understanding of this disorder. Importantly, comorbidities have been shown to influence symptoms and prognosis, and, consequently, they should be carefully addressed. In this sense, it is mandatory to join forces with a multidisciplinary team in order to achieve high-quality care. However, HFpEF remains largely under-recognized and under-treated in clinical practice, and the diagnostic and therapeutic management of these patients remains challenging. The aim of this paper is to articulate a pragmatic approach for patients with HFpEF focusing on the etiology, diagnosis, and treatment of HFpEF.

Knowledge about self-efficacy and outcomes in patients with heart failure and reduced ejection fraction

AIM

Although education in self-management is thought to be an important aspect of the care of patients with heart failure, little is known about whether self-rated knowledge of self-management is associated with outcomes. The aim of this study was to assess the relationship between patient-reported knowledge of self-management and clinical outcomes in patients with heart failure and reduced ejection fraction (HFrEF).

METHODS AND RESULTS

Using individual patient data from three recent clinical trials enrolling participants with HFrEF, we examined patient characteristics and clinical outcomes according to responses to the 'self-efficacy' questions of the Kansas City Cardiomyopathy Questionnaire. One question quantifies patients' understanding of how to prevent heart failure exacerbations ('prevention' question) and the other how to manage complications when they arise ('response' question). Self-reported answers from patients were pragmatically divided into: poor (do not understand at all, do not understand very well, somewhat understand), fair (mostly understand), and good (completely understand). Cox-proportional hazard models were used to evaluate time-to-first occurrence of each endpoint, and negative binomial regression analysis was performed to compare the composite of total (first and repeat) heart failure hospitalizations and cardiovascular death across the above-defined groups. Of patients (n = 17 629) completing the 'prevention' question, 4197 (23.8%), 6897 (39.1%), and 6535 (37.1%) patients had poor, fair, and good self-rated knowledge, respectively. Of those completing the 'response' question (n = 17 637), 4033 (22.9%), 5463 (31.0%), and 8141 (46.2%) patients had poor, fair, and good self-rated knowledge, respectively. For both questions, patients with 'poor' knowledge were older, more often female, and had a worse heart failure profile but similar treatment. The rates (95% confidence interval) per 100 person-years for the primary composite outcome for 'poor', 'moderate' and 'good' self-rated knowledge in answer to the 'prevention' question were 12.83 (12.11-13.60), 12.08 (11.53-12.65) and 11.55 (11.00-12.12), respectively, and for the 'response' question were 12.88 (12.13-13.67), 12.22 (11.60-12.86) and 11.56 (11.07-12.07), respectively. The lower event rates in patients with 'good' self-rate knowledge were accounted for by lower rates of cardiovascular (and all-cause) death and not hospitalization for worsening heart failure.

CONCLUSIONS

Poor patient-reported 'self-efficacy' may be associated with higher rates of mortality. Evaluation of knowledge of 'self-efficacy' may provide prognostic information and a guide to which patients may benefit from further education about self-management.