A randomized trial of a nurse-led educational intervention in patients with heart failure and their caregivers: impact on caregiver outcomes

Personalizing Care for Informal Heart Failure Caregivers: Challenges and Practical Implications

PURPOSE OF REVIEW

To summarize articles describing how to personalize care for heart failure (HF) informal caregivers on the basis of the literature review results. We also describe informal caregivers' preferences and wishes regarding personalized care.

RECENT FINDINGS

Recent interventions to support informal caregivers were delivered face-to-face or online in group or individual sessions. The sessions embraced various elements, including coaching on setting personalized goals and developing problem-solving strategies. The interventions improved a range of variables, such as caregiver burden, quality of life, depression, stress and anxiety. Informal caregivers described personalized care as being in a partnership, clear communication and coordination of care. Several intervention studies reported positive caregiver effects; however, they were small, and sometimes, the interventions were only briefly described. A deeper and more comprehensive understanding of the experiences and needs of informal caregivers is essential before new tailored interventions can be developed.

The Impact of Individual Cognitive Stimulation Therapy on Caregivers of Burn Patients

This study aimed to investigate the effects of Individual Cognitive Stimulation Therapy (ICST) on the cognition, quality of life, and family relationships of caregivers of burn patients. A total of 98 caregivers of burn patients were randomly divided into a control group and a study group. The control group received routine interventions, while the study group underwent ICST, focusing on psychological diagnosis, comprehension, communication, and reeducation phases. Burn awareness levels, quality of life, social support utilization, and psychological resilience were assessed before and after the intervention. Before intervention, there were no significant differences in burn awareness levels, quality of life, social support utilization, or psychological resilience between the 2 groups. After the intervention, caregivers in the study group exhibited significantly higher scores in burn awareness levels, quality of life dimensions, social support utilization, and psychological resilience compared to the control group (P < .05). Individual cognitive stimulation therapy can improve the burn awareness level, quality of life, and social support utilization of caregivers of burn patients, highlighting its significant clinical implications in enhancing caregiver well-being and patient care.

Transitional Care Interventions in Improving Patient and Caregiver Outcomes After Discharge: A Scoping Review

Background. Caregivers play a fundamental role in the complexity of the transitional process between different healthcare settings. Current research shows that caregiver preparedness can affect the quality and efficacy of post-hospital care, therefore highlighting the need to integrate caregiver roles into the design of transitional care processes. This study aims to map existing evidence on effectiveness of transitional care interventions in improving post-discharge outcomes, as well as the influence of caregiver involvement on both patients and caregivers' outcomes. Methods. Referring to PRISMA-ScR guidelines, a systematic search was conducted between January and February 2024 on Scopus, WoS and PubMed. In order to be included in the systematic search, a study was required to use a RCT design, as well as to describe a transitional care intervention targeting caregivers or patient-caregiver dyads applied in the inpatient setting, lastly the study had to include follow-ups after discharge. There were no limitations on the country or publication year. Results. The review has included 51 RCTs of transitional care interventions, discussing caregivers' roles in improving dyad outcomes after discharge. Although the review highlighted a heterogeneity in the transitional care interventions, it was observed that the interventions shared some common components categorized in the following clusters: need assessments, providing information, psychological support, self-management training, and monitoring or follow-up. Conclusions. This review emphasizes the important role of caregivers in the transition from hospital to home, addressing a significant gap in the literature. It highlights the effectiveness of transitional care interventions in improving patients' quality of life and functional abilities while reducing caregivers' burden and depression. Further research should focus on assessing the efficacy of these interventions in relation to healthcare utilization, hospital readmission rates, and emergency department visits.

Latent profile analysis of anticipatory grief in family caregivers of patients with chronic heart failure and its influencing factors

BACKGROUND

Anticipatory grief has been shown to be highly prevalent among family caregivers of patients with advanced illness. However, there is less research on the anticipatory grief of family caregivers with chronic heart failure. Therefore, the purpose of this study was to explore the profile of anticipatory grief among family caregivers of patients with chronic heart failure and to analyze the influencing factors of different profiles.

METHODS

A convenience sampling method was adopted to select 205 family caregivers of chronic heart failure patients hospitalized in a tertiary general hospital in Nanchong, China as the research subjects. A general information questionnaire, Anticipatory Grief Scale (AGS), and Fear of Progression Questionnaire-Short Form (FoP-Q-SF) were used for the survey. Latent profile analysis was conducted on the anticipatory grief of family caregivers of chronic heart failure patients, and univariate analysis and multinomial logistic regression analysis were used to explore the influencing factors of anticipatory grief in each subgroup.

RESULTS

The anticipatory grief of family caregivers of chronic heart failure patients has been divided into three latent classes: low anticipatory grief class (16.4%), moderate anticipatory grief class (58.7%), and high anticipatory grief and loss class (24.8%). Gender, education, relationship with the patient, course of disease, and fear of progression were the influencing factors of the latent profile of anticipatory grief among family caregivers of chronic heart failure patients (all P < 0.05).

CONCLUSION

There were differences in the level of anticipatory grief among different subgroups of family caregivers of chronic heart failure patients. Medical staff can develop personalized intervention measures on the basis of the influencing factors of different categories to alleviate anticipatory grief of family caregivers and promote physical and mental health of caregivers in chronic heart failure patients.

Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study

BACKGROUND

While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake.

OBJECTIVES

To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing.

PATIENTS AND METHODS

This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist.

RESULTS

Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role's responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making.

CONCLUSION

Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients' daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.

Effects of dyadic care interventions for heart failure on patients' and caregivers' outcomes: A systematic review, meta-analysis and meta-regression

BACKGROUND

The contemporary model for managing heart failure has been extended to a patient-family caregiver dyadic context. However, the key characteristics of the model that can optimise health outcomes for both patients and caregivers remain to be investigated.

OBJECTIVES

This study aimed to identify the effects of dyadic care interventions on the behavioural, health, and health-service utilisation outcomes of patients with heart failure and their family caregivers and to explore how the intervention design characteristics influence these outcomes.

DESIGN

This study involved systematic review, meta-analysis, and meta-regression techniques.

METHODS

We performed a systematic review and meta-analysis, using 12 databases to identify randomised controlled trials or quasi-experimental studies published in English or Chinese between database inception and 31 December 2022. The considered interventions included those targeting patients with heart failure and their family caregivers to enhance disease management. Data synthesis was performed on various patient- and caregiver-related outcomes. The identified interventions were categorised according to their design characteristics for subgroup analysis. Meta-regression was performed to explore the relationship between care delivery methods and their effectiveness.

RESULTS

We identified 48 studies representing 9171 patient-caregiver dyads. Meta-analyses suggested the positive effects of dyadic care interventions on patients' health outcomes [Hedges' g (95 % confidence interval {CI}): heart failure knowledge = 1.0 (0.26, 1.75), p = 0.008; self-care confidence = 0.45 (0.08, 0.83), p = 0.02; self-care maintenance = 1.12 (0.55, 1.70), p < 0.001; self-care management = 1.01 (0.54, 1.49), p < 0.001; anxiety = -0.18 (-0.34, -0.02), p = 0.03; health-related quality of life = 0.30 (0.08, 0.51), p < 0.001; hospital admission (risk ratio {95 % CI}: hospital admission = 0.79 (0.65, 0.97), p = 0.007; and mortality = 0.58 (0.36, 0.93), p = 0.02)]. Dyadic care interventions also improved the caregivers' outcomes [Hedges' g (95 % CI): social support = 0.67 (0.01, 1.32), p = 0.05; perceived burden = -1.43 (-2.27, -0.59), p < 0.001]. Although the design of the identified care interventions was heterogeneous, the core care components included enabling and motivational strategies to improve self-care, measures to promote collaborative coping within the care dyads, and nurse-caregiver collaborative practice. Incorporating the first two core components appeared to enhance the behavioural and health outcomes of the patients, and the addition of the last component reduced readmission. Interventions that engaged both patients and caregivers in care provision, offered access to nurses, and optimised continuity of care led to better patient outcomes.

CONCLUSIONS

These findings demonstrate that dyadic care interventions can effectively improve disease management in a family context, resulting in better health outcomes for both patients and caregivers. Additionally, this study provides important insights into the more-effective design characteristics of these interventions.

REGISTRATION NUMBER

The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42022322492).

Social Determinants of Health are Associated with Coping of Informal Caregivers of Adults with Heart Failure

We explored the influence of social determinants of health (SDH) risk on stress and coping style in heart failure (HF) caregivers. In this cross-sectional study, data from 250 caregivers were analyzed. Multivariable linear regression analyses were performed to determine the extent to which SDH risk (measured using a modified PRAPARE tool (National Association of Community Health Centers), range 0-22) predicted stress (Perceived Stress Scale, 0-56) and coping style (active (0-45), avoidance (0-30), and minimization (0-30)) while accounting for caregiver burden (HF Caregiver Questionnaire (HF-CQ) 0-100). Multivariable regression analysis with backwards elimination variable selection approach was used to identify which SDH risk factors best predicted coping styles. SDH risk was significantly associated with avoidance and minimization coping styles. Each unit increase in SDH risk was associated with an increase of 0.6 ± 0.2 units (p = .0008) in avoidance and 0.7 ± 0.2 units (p < .0001) in minimization coping style. Race and "supporting others" significantly predicted avoidance coping style; scores were 3.3 ± 0.8 units greater for caregivers who were not White (p < .0001) and 1.4 ± 0.5 units greater (p < .01) for each additional person whom they supported. Race significantly predicted minimization coping style; scores were 4.4 ± 0.7 units greater for caregivers who were not White (p < .0001). Caregivers with higher SDH risk may avoid and minimize to cope with caregiving challenges.

Acute Heart Failure Is a Malignant Process: But We Can Induce Remission

Acute heart failure is a common and increasingly prevalent condition, affecting >10 million people annually. For those patients who survive to discharge, early readmissions and death rates are >30% everywhere on the planet, making it a malignant condition. Beyond these adverse outcomes, it represents one of the largest drivers of health care costs globally. Studies in the past 2 years have demonstrated that we can induce remissions in this malignant process if therapy is instituted rapidly, at the first acute heart failure episode, using full doses of all available effective medications. Multiple studies have demonstrated that this goal can be achieved safely and effectively. Now the urgent call is for all stakeholders, patients, physicians, payers, politicians, and the public at large to come together to address the gaps in implementation and enable health care providers to induce durable remissions in patients with acute heart failure.

Integration of a Smartphone HF-Dedicated App in the Remote Monitoring of Heart Failure Patients with Cardiac Implantable Electronic Devices: Patient Access, Acceptance, and Adherence to Use

(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal option to remotely collect this information.

PURPOSE

To assess real-world HF patient access, acceptance, and adherence to use of an HF-dedicated smartphone application (HF app).

METHODS

In this study, 10 Italian hospitals administered a survey on smartphone/app use to HF patients with CIED. The subgroup who accepted it downloaded the HF app. Mean 1-year adherence of the HF app use was evaluated.

RESULTS

A total of 495 patients (67 ± 13 years, 79% males, 26% NYHA III-IV) completed the survey, of which 84% had access to smartphones and 85% were willing to use the HF app. In total, 311/495 (63%) downloaded the HF app. Patients who downloaded the HF app were younger and had higher school qualification. Patients who were ≥60 years old had higher mean 1-year adherence (54.1%) than their younger counterparts (42.7%; p < 0.001). Hospitals with RM-dedicated staff had higher mean 1-year patient adherence (64.0% vs. 33.5%; p < 0.001). Adherence to HF app decreased from 63.3% (weeks_1-13) to 42.2% (weeks_40-52, p < 0.001).

CONCLUSIONS

High access and acceptance of smartphones/apps by HF patients with CIED allow HF app use for RM of patient signs/symptoms. Younger patients with higher school qualifications are more likely to accept HF app; however, older patients have higher long-term adherence.

Pre-discharge and early post-discharge management of patients hospitalized for acute heart failure: A scientific statement by the Heart Failure Association of the ESC

Acute heart failure is a major cause of urgent hospitalizations. These are followed by marked increases in death and rehospitalization rates, which then decline exponentially though they remain higher than in patients without a recent hospitalization. Therefore, optimal management of patients with acute heart failure before discharge and in the early post-discharge phase is critical. First, it may prevent rehospitalizations through the early detection and effective treatment of residual or recurrent congestion, the main manifestation of decompensation. Second, initiation at pre-discharge and titration to target doses in the early post-discharge period, of guideline-directed medical therapy may improve both short- and long-term outcomes. Third, in chronic heart failure, medical treatment is often left unchanged, so the acute heart failure hospitalization presents an opportunity for implementation of therapy. The aim of this scientific statement by the Heart Failure Association of the European Society of Cardiology is to summarize recent findings that have implications for clinical management both in the pre-discharge and the early post-discharge phase after a hospitalization for acute heart failure.