Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Extending the Horizon in Chronic Heart Failure: Effects of Multidisciplinary, Home-Based Intervention Relative to Usual Care A telephone-delivered empowerment intervention with patients diagnosed with heart failure. Just-in-time evidence-based e-mail "reminders" in home health care: impact on patient outcomes. Design and methodology of the COACH study: a multicenter randomised Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. Effects of education and support on self-care and resource utilization in patients with heart failure. The Efficacy of a Motivational Nursing Intervention Based on the Stages of Change on Self-care in Heart Failure Patients A heart failure self-management program for patients of all literacy levels: A randomized, controlled trial [ISRCTN11535170] Evaluation of a self-management programme for congestive heart failure patients: design of a randomised controlled trial The impact of nurse‐directed patient education on quality of life and functional capacity in people with heart failure Quality of Life of Individuals With Heart Failure: A Randomized Trial of the Effectiveness of Two Models of Hospital-to-Home Transition Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Increasing self-management skills in heart failure patients: a pilot study. A pilot study: reports of benefits from a 6-month, multidisciplinary, shared medical appointment approach for heart failure patients. Randomised trial of telephone intervention in chronic heart failure: DIAL trial Feasibility of a group-based self-management program among congestive heart failure patients. Comparison of a one-time educational intervention to a teach-to-goal educational intervention for self-management of heart failure: design of a randomized controlled trial Rationale, design and conduct of a randomised controlled trial evaluating a primary care-based complex intervention to improve the quality of life of heart failure patients: HICMan (Heidelberg Integrated Case Management) Using instrumented paper diaries to document self-monitoring patterns in weight loss. Randomized, Controlled Evaluation of Short- and Long-Term Benefits of Heart Failure Disease Management Within a Diverse Provider Network: The SPAN-CHF Trial The effect of a tailored message intervention on heart failure readmission rates, quality of life, and benefit and barrier beliefs in persons with heart failure. Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression. Feasibility of a nurse-monitored, outpatient-care programme for elderly patients with moderate-to-severe, chronic heart failure. The effect of shared medical visits on knowledge and self-care in patients with heart failure: a pilot study. Testing Videotape Education for Heart Failure A Motivational Counseling Approach to Improving Heart Failure Self-Care: Mechanisms of Effectiveness A randomized clinical trial of the clinical effects of enhanced heart failure monitoring using a computer-based telephonic monitoring system in older minorities and women. Care Management for Low-Risk Patients with Heart Failure A Randomized Intervention to Improve Heart Failure Outcomes in Community-Based Home Health Care Telephone Follow-Up of Self-Care Behaviour after a Single Session Education of Patients with Heart Failure in Primary Health Care "I am not alone": the feasibility and acceptability of interactive voice response-facilitated telephone peer support among older adults with heart failure. Impact of a comprehensive telephone-based disease management programme on quality-of-life in patients with heart failure. Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure. A Randomized Trial of Telenursing to Reduce Hospitalization for Heart Failure: Patient-Centered Outcomes and Nursing Indicators A simplified education program improves knowledge, self-care behavior, and disease severity in heart failure patients in rural settings. Is Individual Peer Support a Promising Intervention for Persons With Heart Failure? Patients' Self-Care Improvement with Nurse Education Intervention in Spain Assessed by the European Heart Failure Self-Care Behaviour Scale Case management in a heterogeneous congestive heart failure population: a randomized controlled trial. Double-disease management or one care manager for two chronic conditions: pilot feasibility study of nurse telephonic disease management for depression and congestive heart failure. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. Compliance and effectiveness of 1 year's home telemonitoring. The report of a pilot study of patients with chronic heart failure The impact of a self-management group programme on health behaviour and healthcare utilization among congestive heart failure patients. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. Randomized Trial of Telephone Intervention in Chronic Heart Failure (DIAL): study design and preliminary observations. Evaluation of a Web-based education and counseling pilot program for older heart failure patients. Computer-based education for patients with chronic heart failure. A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life. Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design. The Heart Failure Adherence and Retention Trial (HART): design and rationale. Uptake of self-management strategies in a heart failure management programme. Self-care and quality of life in patients with advanced heart failure: the effect of a supportive educational intervention. Motivational interviewing to change quality of life for people with chronic heart failure: a randomised controlled trial.
BACKGROUND Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use .  Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized .  Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches Background — The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown . Methods and Results — The effects of a nurse-led , multidisciplinary , home-based intervention ( HBI ) in a typically elderly cohort of patients with chronic heart failure initially r and omized to either HBI ( n=149 ) or usual postdischarge care ( UC ) ( n=148 ) after a short-term hospitalization were studied for up to 10 years of follow-up ( minimum 7.5 years of follow-up ) . Study end points were all-cause mortality , event-free survival ( event was defined as death or unplanned hospitalization ) , recurrent hospital stay , and cost per life-year gained . Median survival in the HBI cohort was almost twice that of UC ( 40 versus 22 months ; P<0.001 ) , with fewer deaths overall ( HBI , 77 % versus 89 % ; adjusted relative risk , 0.74 ; 95 % CI , 0.53 to 0.80 ; P<0.001 ) . HBI was associated with prolonged event-free survival ( median , 7 versus 4 months ; P<0.01 ) . HBI patients had more unplanned readmissions ( 560 versus 550 ) but took 7 years to overtake UC ; the rates of readmission ( 2.04±3.23 versus 3.66±7.62 admissions ; P<0.05 ) and related hospital stay ( 14.8±23.0 versus 28.4±53.4 days per patient per year ; P<0.05 ) were significantly lower in the HBI group . HBI was associated with 120 more life-years per 100 patients treated compared with UC ( 405 versus 285 years ) at a cost of $ 1729 per additional life-year gained when we accounted for healthcare costs including the HBI . Conclusions — In altering the natural history of chronic heart failure relative to UC ( via prolonged survival and reduced frequency of recurrent hospitalization  ) , HBI is a remarkably cost- and time-effective strategy over the longer term BACKGROUND Heart failure ( HF ) is a major public health problem . Case management by nurses using telephone follow-up has been suggested as a convenient and effective mechanism to promote the self-management of HF . Similarly , a patient empowerment approach to the management of chronic disease has been suggested as one that may nurture self-management in individuals with chronic illness . OBJECTIVE The purpose of this study was to examine the effects of a telephone-delivered empowerment intervention ( EI ) on clinical ly and theoretically relevant outcomes in patients with HF , including purpose ful participation in goal attainment , self-management of HF , and perception of functional health . The EI was guided by Rogers ' Science of Unitary Human Beings person-environment process . METHODS A convenience sample of men and women aged 21 years and older with a clinical diagnosis of HF was obtained from a metropolitan hospital located in the southwestern United States . The participants were r and omly assigned to the control group ( n = 45 ) or EI group ( n = 45 ) . All participants received st and ardized HF patient education ; the intervention group also received an EI delivered through telephone follow-up calls from a registered nurse . Repeated- measures analysis of variance was used to evaluate intervention effects . RESULTS The telephone-delivered EI  facilitated self-management of HF through self-care activities in EI group members . CONCLUSION The knowledge gained from this study provides a beginning underst and ing of strategies to enhance health care providers ' ability to facilitate self-management of HF among patients diagnosed with HF OBJECTIVE To assess the impact and cost-effectiveness of two information-based provider reminder interventions design ed to improve self-care management and outcomes of heart failure ( HF ) patients . DATA SOURCES / STUDY SETTING Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF . STUDY DESIGN Patients were treated by nurses r and omly assigned to usual care or one of two intervention groups . The basic intervention was an e-mail to the patient 's nurse highlighting six HF-specific clinical recommendations . The augmented intervention supplemented the initial nurse reminder with additional clinician and patient re sources . DATA COLLECTION Patient interviews were conducted 45 days post admission to measure self-management behaviors , HF-specific outcomes ( Kansas City Cardiomyopathy Question naire-KCCQ ) , health-related quality of life ( EuroQoL ) , and service use . PRINCIPAL FINDINGS Both interventions improved the mean KCCQ summary score ( 15.3 and 12.9 percent , respectively ) relative to usual care ( p < or = .05 ) . The basic intervention also yielded a higher EuroQoL score relative to usual care ( p < or = .05 ) . In addition , the interventions had a positive impact on medication knowledge , diet , and weight monitoring . The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes . CONCLUSIONS This study demonstrates the positive impact of targeting evidence -based computer reminders to home health nurses to improve patient self-care behaviors , knowledge , and clinical outcomes . It also advances the field 's limited underst and ing of the cost-effectiveness of selected strategies for translating research into practice BACKGROUND While there are data to support the use of comprehensive non-pharmacological intervention programs in patients with heart failure ( HF ) , other studies have not confirmed these positive findings . Substantial differences in the type and intensity of disease management programs make it impossible to draw definitive conclusions about the effectiveness , optimal timing and frequency of interventions . AIMS 1 . To determine the effectiveness of two interventions ( basic support vs. intensive support ) compared to ' care as usual ' in HF patients , on time to first major event ( HF readmission or death ) , quality of life and costs . 2 . To investigate the role of underlying mechanisms ( knowledge , beliefs , self-care behaviour , compliance ) on the effectiveness of the two interventions . METHODS This is a r and omised controlled trial in which 1050 patients with heart failure will be r and omised into three treatment arms : care as usual , basic education and support or intensive education and support . Outcomes of this study are ; time to first major event ( HF hospitalisation or death ) , quality of life ( Minnesota Living with HF Question naire , R AND 36 and Ladder of Life ) and costs . Data will be collected during initial admission and then 1 , 6 , 12 , and 18 months after discharge . In addition , data on knowledge , beliefs , self-care behaviour and compliance will be collected . RESULTS The study started in January 2002 and results are expected at the end of 2005 . CONCLUSIONS This study will help health care providers in future to make rational and informed choices about which components of a HF management program should be exp and ed and which components can possibly be deleted AIMS To test the effect of education and support by a nurse on self-care and re source utilization in patients with heart failure . METHODS A total of 179 patients ( mean age 73 , 58 % male , NYHA III-IV ) hospitalized with heart failure were evaluated prospect ively . Patients were r and omized to the study intervention or to ' care as usual '  . The supportive educative intervention consisted of intensive , systematic and planned education by a study nurse about the consequences of heart failure in daily life , using a st and ard nursing care plan developed by the research ers for older patients with heart failure . Education and support took place during the hospital stay and at a home visit within a week of discharge . Data were collected on self-care abilities , self-care behaviour , readmissions , visits to the emergency heart centre and use of other health care re sources . RESULTS Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure . Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge , but the increase in the intervention group was significantly more after 1 month . Although self-care behaviour in both groups decreased during the following 8 months , the increase from baseline remained statistically significant in the intervention group , but not in the control group . No significant effects on re source utilization were found . CONCLUSIONS Intensive , systematic , tailored and planned education and support by a nurse results in an increase in patients ' self-care behaviour . No significant effects were found on use of health care re sources . Additional organisational changes , such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support Background and Research Objective : Heart failure ( HF ) patients experience frequent episodes of decompensation . While medication and behavior change play a major role in maintaining physiological stability , patient adherence to self-care recommendations is not optimal . The Theory of Heart Failure Self-care helped to underst and the concepts of self-care and chose a model of intervention . Conviction and confidence are central factors in facilitating self-care . Motivational interviewing ( MI ) , which aims to strengthen conviction and confidence , has been shown to improve self-care . In addition , the Transtheoretical Model , based on patients ' readiness to change , also has proven efficacy . The MI based on the stages of change ( MISC ) , a combination of MI and Transtheoretical Model , offers promise for improving self-care . The goal of this pilot study was to evaluate the preliminary effect of an MISC intervention on HF patients ' self-care behaviors . Subjects and Method : Thirty patients were recruited from an HF clinic and r and omly assigned to an experimental ( EG ) or control group ( n = 15/group ) . Patients from the EG received 3 interventions ( 1 in person , 2 on the phone ) . Data were collected at baseline and at 1 month after r and omization . The effect of the intervention was assessed on 5 self-care outcomes using analysis -of-covariance models . Results and Conclusion : Significant results were obtained regarding the confidence in performing self-care behaviors specific to HF ( P = .005 ) . Although the results of the other hypotheses were not statistically significant , for the majority , trends were in the expected direction in favor of the EG . The study suggests that an MISC intervention is useful to increase patients ' confidence in HF self-care and has potential to improve self-care . Further research is needed Background Self-management programs for patients with heart failure can reduce hospitalizations and mortality . However , no programs have analyzed their usefulness for patients with low literacy . We compared the efficacy of a heart failure self-management program design ed for patients with low literacy versus usual care .  Methods We performed a 12-month r and omized controlled trial . From November 2001 to April 2003 , we enrolled participants aged 30–80 , who had heart failure and took furosemide .  Intervention patients received education on self-care emphasizing daily weight measurement , diuretic dose self-adjustment , and symptom recognition and response . Picture-based educational material s , a digital scale , and scheduled telephone follow-up were provided to reinforce adherence . Control patients received a generic heart failure brochure and usual care . Primary outcomes were combined hospitalization or death , and heart failure-related quality of life . Results 123 patients ( 64 control , 59 intervention ) participated ; 41 % had inadequate literacy . Patients in the intervention group had a lower rate of hospitalization or death ( crude incidence rate ratio ( IRR ) = 0.69 ; CI 0.4 , 1.2 ; adjusted IRR = 0.53 ; CI 0.32 , 0.89 ) . This difference was larger for patients with low literacy ( IRR = 0.39 ; CI 0.16 , 0.91 ) than for higher literacy ( IRR = 0.56 ; CI 0.3 , 1.04 ) , but the interaction was not statistically significant . At 12 months , more patients in the intervention group reported monitoring weights daily ( 79 % vs. 29 % , p < 0.0001 ) . After adjusting for baseline demographic and treatment differences , we found no difference in heart failure-related quality of life at 12 months ( difference = -2 ; CI -5 , + 9 ) . Conclusion A primary care-based heart failure self-management program design ed for patients with low literacy reduces the risk of hospitalizations or death Background Congestive heart failure ( CHF ) has a substantial impact on care utilisation and quality of life . It is crucial for patients to cope with CHF adequately , if they are to live an acceptable life . Self-management may play an important role in this regard . Previous studies have shown the effectiveness of the ' Chronic Disease Self-Management Program ' ( CDSMP ) , a group-based cognitive behavioural programme for patients with various chronic conditions . However , the programme 's effectiveness has not yet been studied specifically among CHF patients . This paper presents the design of a r and omised controlled trial to evaluate the effects of the CDSMP on psychosocial attributes , health behaviour , quality of life , and health care utilisation of CHF patients . Methods / Design The programme is being evaluated in a two-group r and omised controlled trial . Patients were eligible if they had been diagnosed with CHF and experienced slight to marked limitation of physical activity . They were selected from the Heart Failure and /or Cardiology Outpatient Clinics of six hospitals . Eligible patients underwent a baseline assessment and were subsequently allocated to the intervention or control group . Patients allocated to the intervention group were invited to attend the self-management programme consisting of six weekly sessions , led by a CHF nurse specialist and a CHF patient . Those allocated to the control group received care as usual . Follow-up measurements are being carried out immediately after the intervention period , and six and twelve months after the start of the intervention . An effect evaluation and a process evaluation are being conducted . The primary outcomes of the effect evaluation are self-efficacy expectancies , perceived control , and cognitive symptom management . The secondary outcome measures are smoking and drinking behaviour , Body Mass Index ( BMI ) , physical activity level , self-care behaviour , health-related quality of life , perceived autonomy , symptoms of anxiety and depression , and health care utilisation . The programme 's feasibility is assessed by measuring compliance with the protocol , patients ' attendance and adherence , and the opinions about the programme .  Discussion A total number of 318 patients were included in the trial . At present , follow-up data are being collected . The results of the trial become clear after completion of the data collection in January 2007.Trial Registration Trialregister ( http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=467 ) IS RCT N88363287 Purpose : The purpose of this research was to evaluate the impact of a nurse‐directed approach to patient education , which focused on lifestyle modification , daily weight management , diet , and medication compliance to improve the quality of life ( QOL ) and functional capacity in people with heart failure . Data sources : This was a prospect i ve quasiexperimental multicenter research study of 23 patients comparing a nurse‐directed care ( NC ) group ( n= 13 ) , which received comprehensive disease management education and weekly telephone follow‐up , and the routine care ( RC ) group ( n= 10 ) that received protocol ‐driven medical management .  The study length was 12 months . Conclusions : Analysis of covariance ( ANCOVA ) was used to test for e quality of variance – covariance matrices in the study population over time . ANCOVA measured baseline and two data intervals for a total of 9 months between the control and experimental ( NC and RC ) groups . There was statistically significant improvement in the NC group for the domains of total QOL : F= 3.569 , p= 0.000 ; health and function : F= 3.995 , p= 0.003 ; social and economic : F= 14.109 , p= 0.000 ; psychological and spiritual : F= 13.212 , p= 0.000 ; and family : F= 2.384 , p= 0.048 . Functional capacity was not significantly impacted by the study team interventions ( F= 0.228 , p= 0.949 ) . Implication s for practice : Results indicate that nurse‐directed patient education was effective in improving QOL .  A nurse‐directed treatment strategy significantly improves patients ’ role in symptom control and disease self‐management Background . The growing number of patients with congestive heart failure has increased both the pressure on hospital re sources 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 , prospect i ve , r and omized 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 Question naire ( 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 ( & khgr;2 = 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 BACKGROUND We examined the effect of a home-based intervention ( HBI ) on readmission and death among " high-risk " patients with congestive heart failure discharged home from acute hospital care . METHODS Hospitalized patients with congestive heart failure and impaired systolic function , intolerance to exercise , and a history of 1 or more hospital admissions for acute heart failure were r and omized to either usual care ( n=48 ) or HBI at 1 week after discharge ( n=49 ) .  Home-based intervention comprised a single home visit ( by a nurse and pharmacist ) to optimize medication management , identify early clinical deterioration , and intensify medical follow-up and caregiver vigilance as appropriate . The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge . Secondary end points included duration of hospital stay and overall mortality . RESULTS During follow-up , patients in the HBI group had fewer unplanned readmissions ( 36 vs 63 ; P=.03 ) and fewer out-of-hospital deaths ( 1 vs 5 ; P=.11 ) : 0.8+/-0.9 vs 1.4+/-1.8 ( mean + /- SD ) events per patient assigned to HBI and usual care , respectively ( P=.03 ) . Patients in the HBI group also had fewer days of hospitalization ( 261 vs 452 ; P=.05 ) and fewer total deaths ( 6 vs 12 ; P=.11 ) . Patients assigned to usual care were more likely to experience 3 or more readmissions for acute heart failure ( P=.02 ) . Predictors of unplanned readmission were ( 1 ) 14 days or more of unplanned readmission during the 6 months before study entry ( odds ratio [ OR ] , 5.2 ; 95 % confidence interval [ CI ] , 1.8 - 16.2 ) , ( 2 ) previous admission for acute myocardial ischemia ( OR , 3.3 ; 95 % CI , 1.2 - 9.1 ) , and ( 3 ) an albumin plasma concentration of 38 g/L or less ( OR , 2.4 ; 95 % CI , 1.2 - 6.0 ) . Home-based intervention was also associated with a trend toward reduced risk of unplanned readmission ( OR , 0.4 ; 95 % CI , 0.2 - 1.1 ) . CONCLUSION Among a cohort of high-risk patients with congestive heart failure , HBI was associated with reduced frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge from the hospital Nonadherence to medical treatment among heart failure patients is high and results in frequent exacerbations and premature death . This treatment-only pilot study examined whether a year-long group-based self-management intervention is feasible and improves self-management skills in patients with mild-to-moderate heart failure ( ejection fraction < or = 40 % and New York Heart Association functional class I , II , or III ) . A total of 31 of 100 recruited patients ( 31 % ) agreed to participate . Twenty-six ( 84 % ) completed the year-long self-management program . Compared with baseline , the intervention was associated with an increase in overall self-efficacy in practicing self-management skills ( p<0.001 ) and in four of five specific self-management skills . Patients and their group leaders also reported an increase in actual use of self-management skills ( p<0.001 ) and in several psychosocial outcomes . The success of this pilot study suggests the need for a r and omized clinical trial to test the efficacy of group-based self-management training on medical outcomes ABSTRACT Heart failure continues to be the leading cause of hospitalization among older adults . Noncompliance with medications , dietary indiscretion , failure to recognize symptoms , and failed social support systems contribute to increased morbidity . Multidisciplinary medical approaches have proven successful for heart failure . In 2004 , the Naval Medical Center San Diego started a multidisciplinary shared medical appointment  for patients with complicated cases of heart failure . Patients enrolled in the heart failure clinic were monitored prospect ively for 6 months . Vali date d question naires concerning satisfaction with care , self-care management , depression , and quality -of-life measures were administered at baseline and 6 months after enrollment . Thirty-nine individuals were enrolled in the clinic , with 33 completing 6 months of follow-up monitoring to date .  Hospital admissions for any cause decreased from 11 to eight , whereas congestive heart failure-related admissions decreased from four to two . There was a total of six deaths . During the 6 months of enrollment , use of angiotensin-converting enzyme inhibitors and beta-receptor blockers had absolute increases of 20 % and 19 % , respectively . Statistically significant improvements were seen in the Beck Depression Inventory and Self-Care Management Index results . A multidisciplinary approach to heart failure patients using the shared medical appointment model can improve patient satisfaction , enhance quality of life , and help reduce hospitalizations while improving provider efficiency Abstract Objective To determine whether a central ised telephone intervention reduces the incidence of death or admission for worsening heart failure in out patients with chronic heart failure . Design Multicentre r and omised controlled trial . Setting 51 centres in Argentina ( public and private hospitals and ambulatory setting s ) . Participants 1518 out patients with stable chronic heart failure and optimal drug treatment r and omised , stratified by attending cardiologist , to telephone intervention or usual care .  Intervention Education , counselling , and monitoring by nurses through frequent telephone follow-up in addition to usual care , delivered from a single centre . Main outcome measure All cause mortality or admission to hospital for worsening heart failure . Results Complete follow-up was available in 99.5 % of patients . The 758 patients in the usual care group were more likely to be admitted for worsening heart failure or to die ( 235 events , 31 % ) than the 760 patients who received the telephone intervention ( 200 events , 26.3 % ) ( relative risk reduction = 20 % , 95 % confidence interval 3 to 34 , P = 0.026 ) . This benefit was mostly due to a significant reduction in admissions for heart failure ( relative risk reduction = 29 % , P = 0.005 ) . Mortality was similar in both groups . At the end of the study the intervention group had a better quality of life than the usual care group ( mean total score on Minnesota living with heart failure question naire 30.6 v 35 , P = 0.001 ) . Conclusions This simple , central ised heart failure programme was effective in reducing the primary end point through a significant reduction in admissions to hospital for heart failure OBJECTIVE This study assessed the feasibility of the Chronic Disease Self-Management Program ( CDSMP ) among patients with congestive heart failure ( CHF ) . The program emphasizes patients ' central role and responsibility in managing their illness . METHODS Patients were r and omly assigned to the program , which was led by a cardiac nurse specialist and a CHF patient .  Data on performance according to protocol , adherence , and opinion about the program were collected among 186 patients and 18 leaders . RESULTS Eighty percent of the group sessions were carried out largely according to protocol . Three fourths of the patients attended at least 4 of the 6 sessions . Female sex and lower New York Heart Association classification predicted good attendance . CONCLUSION Directly after the program and at 12-month follow-up , approximately three fourths of the patients stated that they had benefited from the program . Recommendations mainly concerned spending more time on several program topics and specifying patient- selection criteria in more detail . The program was considered feasible Background Heart failure ( HF ) is common , costly and associated with significant morbidity and poor quality of life , particularly for patients with low socioeconomic status .  Self-management training has been shown to reduce HF related morbidity and hospitalization rates , but there is uncertainty about how best to deliver such training and what patients benefit . This study compares a single session self-management HF training program against a multiple session training intervention and examines whether their effects differ by literacy level . Methods / Design In this r and omized controlled multi-site trial , English and Spanish-speaking patients are recruited from university-affiliated General Internal Medicine and Cardiology clinics at 4 sites across the United States . Eligible patients have HF with New York Heart Association class II-IV symptoms and are prescribed a loop diuretic . Baseline data , including literacy level , are collected at enrollment and follow-up surveys are conducted at 1 , 6 and 12 monthsUpon enrollment , both the control and intervention groups receive the same 40 minute , literacy-sensitive , in-person , HF education session covering the 4 key self-management components of daily self assessment and having a plan , salt avoidance , exercise , and medication adherence . All participants also receive a literacy-sensitive workbook and a digital bathroom scale . After the baseline education was completed , patients are r and omly allocated to return to usual care or to receive ongoing education and training . The intervention group receives an additional 20 minutes of education on weight and symptom-based diuretic self-adjustment , as well as periodic follow-up phone calls from the educator over the course of 1 year . These phone calls are design ed to reinforce the education , assess participant knowledge of the education and address barriers to success . The primary outcome is the combined incidence of all cause hospitalization and death . Secondary outcomes include HF-related quality of life , HF-related hospitalizations , knowledge regarding HF , self-care behavior , and self-efficacy . The effects of each intervention will be stratified by patient literacy , in order to identify any differential effects . Discussion Enrollment of the proposed 660 subjects will continue through the end of 2009 . Outcome assessment s are projected to be completed by early 2011.Trial Registration Clinical Trials.gov http://www . clinical trials.gov/ Background Chronic congestive heart failure ( CHF ) is a complex disease with rising prevalence , compromised quality of life ( QoL ) , unplanned hospital admissions , high mortality and therefore high burden of illness . The delivery of care for these patients has been criticized and new strategies addressing crucial domains of care have been shown to be effective on patients ' health outcomes , although these trials were conducted in secondary care or in highly organised Health Maintenance Organisations . It remains unclear whether a comprehensive primary care-based case management for the treating general practitioner ( GP ) can improve patients ' QoL. Methods / Design HICMan is a r and omised controlled trial with patients as the unit of r and omisation . Aim is to evaluate a structured , st and ardized and comprehensive complex intervention for patients with CHF in a 12-months follow-up trial . Patients from intervention group  receive specific patient leaflets and documentation booklets as well as regular monitoring and screening by a prior trained practice nurse , who gives feedback to the GP upon urgency . Monitoring and screening address aspects of disease-specific self-management , (non)pharmacological adherence and psychosomatic and geriatric comorbidity . GPs are invited to provide a tailored structured counselling 4 times during the trial and receive an additional feedback on pharmacotherapy relevant to prognosis ( data of baseline documentation ) .  Patients from control group receive usual care by their GPs , who were introduced to guideline -oriented management and a tailored health counselling concept . Main outcome measurement for patients ' QoL is the scale physical functioning of the SF-36 health question naire in a 12-month follow-up . Secondary outcomes are the disease specific QoL measured by the Kansas City Cardiomyopathy question naire ( KCCQ ) , depression and anxiety disorders ( PHQ-9 , GAD-7 ) , adherence ( EHFScBS and SANA ) , quality of care measured by an adapted version of the Patient Chronic Illness Assessment of Care question naire ( PACIC ) and NT-proBNP . In addition , comprehensive clinical data are collected about health status , comorbidity , medication and health care utilisation . Discussion As the targeted patient group is mostly cared for and treated by GPs , a comprehensive primary care-based guideline implementation including somatic , psychosomatic and organisational aspects of the delivery of care ( HICMAn ) is a promising intervention applying proven strategies for optimal care . Trial registration Current Controlled Trials IS RCT N30822978 Self-monitoring of eating is associated with successful weight loss , but adherence is imperfect and deteriorates over time . Moreover , intentionally or not , many individuals have difficulty keeping faithful records . We used instrumented paper diaries ( IPDs ) to study self-monitoring  in r and omly chosen participants in the PREFER trial , a behavioral treatment for weight-loss study . The diaries they used to self-report eating were periodically replaced with IPDs at various times during an 18-month weight-loss program , consisting of three successive phases : intense treatment ( n=35 ) , less-intense treatment ( n=13 ) , and maintenance ( n=16 ) . We compared electronically documented self-monitoring data , showing when and how often IPDs were used , with self-reported data , then compared the electronically vali date d adherence and weight loss . Self-reported diary usage exceeded IPD-documented usage while the electronic data demonstrated a significant decline in self-monitoring over time . Diary recording often was not timely . Percentage weight lost correlated significantly with frequency of IPD use ( p=.001 ) and the number of diary entries made within 15 min of opening the IPD ( p=.002 ) . This is the first study to document patterns of self-monitoring among participants in a weight-loss program , which demonstrated that individuals may falsify the times and frequency of self-monitoring . Furthermore , our results showed that adherence to self-monitoring and the timeliness of recording significantly correlate with improved weight loss Background —Several trials support the usefulness of disease management ( DM ) for improving clinical outcomes in heart failure ( HF ) . Most of these studies are limited by small sample size ; absence of concurrent , r and omized controls ; limited follow-up ; restriction to urban academic centers ; and low baseline use of effective medications . Methods and Results —We performed a prospect i ve , r and omized assessment of the effectiveness of HF DM delivered for 90 days across a diverse provider network in a heterogeneous population of 200 patients with high baseline use of approved HF pharmacotherapy . During a 90-day follow-up , patients r and omized to DM experienced fewer hospitalizations for HF [ primary end point , 0.55±0.15 per patient-year alive versus 1.14±0.22 per patient-year alive in control subjects ; relative risk ( RR ) , 0.48 , P=0.027 ] . Intervention patients experienced reductions in hospital days related to a primary diagnosis of HF ( 4.3±0.4 versus 7.8±0.6 days hospitalized per patient-year ; RR , 0.54 ; P<0.001 ) , cardiovascular hospitalizations ( 0.81±0.19 versus 1.43±0.24 per patient-year alive ; RR , 0.57 ; P=0.043 ) , and days in hospital per patient-year alive for cardiovascular cause ( RR , 0.64 ; P<0.001 ) . Intervention patients showed a trend toward reduced all-cause hospitalizations and total hospital days . On long-term ( mean , 283 days ) follow-up , there was substantial attrition of the 3-month gain in outcomes , with sustained significant reduction only in days in hospital for cardiac cause . Conclusions —In a population with high background use of st and ard HF therapy  , a DM intervention , uniformly delivered across varied clinical sites , produced significant short-term improvement in HF-related clinical outcomes . Longer-term benefit likely requires more active chronic intervention , even among patients who appear clinical ly stable OBJECTIVE The purpose of this study was to determine the effect of a tailored message intervention on heart failure readmission rates , quality of life , and health beliefs in persons with heart failure ( HF ) . DESIGN This r and omized control trial provided a tailored message intervention during hospitalization and 1 week and 1 month after discharge . Theoretic framework The organizing framework was the Health Belief Model . SUBJECTS Seventy persons with a primary diagnosis of chronic HF were included in the study . RESULTS HF readmission rates and quality of life did not significantly differ between the treatment and control groups . Health beliefs , except for benefits of medications , significantly changed from baseline in the treatment group in directions posited by the Health Belief Model . CONCLUSIONS A tailored message intervention changed the beliefs of the person with HF in regard to the benefits and barriers of taking medications , following a sodium-restricted diet , and self-monitoring for signs of fluid overload . Future research is needed to explore the effect of health belief changes on actual self-care behaviors AIMS To determine the effects of a nurse-led intervention design ed to improve self-management of patients with heart failure in a primary health care setting regarding health-related quality of life and depression . METHODS Patients at eight primary health care centres were screened by the Diagnosis Related Groups registry for the diagnosis of heart failure and eligibility for a cluster r and omised study . A total of 153 patients were included ( n=78 in the intervention group , 54 % males , mean age 79 years , 59 % in New York Heart Association class III-IV ) . The intervention involved patient and family education about heart failure and self-management and monthly telephone follow-up during 12 months by a primary health care nurse . RESULTS The effects of the nurse-led intervention were limited . Significant differences were found in the physical dimension measured by the SF-36 health survey , and in depression measured by the Zung Self-rating Depression Scale . In comparison within groups at the 3 and 12-month follow-up , the intervention group significantly maintained their health-related quality of life measured by the SF-36 health survey , and their experience of depression measured by the Zung Self-rating Depression Scale to a greater extent than in the control group , especially among women . CONCLUSION A nurse-led intervention directed toward patients with heart failure in a primary health care setting result ed in limited effects between the groups , although the physical and mental status were retained during 12 months of follow-up to a greater extent than in the control group AIMS To evaluate the feasibility of a nurse-monitored , outpatient-care program for elderly patients previously hospitalized with chronic heart failure . METHODS AND RESULTS Patients with chronic heart failure hospitalized in the medical wards were screened to find those eligible for a r and omized study to compare the effect of a nurse-monitored , outpatient-care programme aim ing at symptom management , with conventional care .  The inclusion criteria were patients classified in New York Heart Association classes III-IV , age 65 years , and eligibility for an outpatient follow-up programme .  The total in-hospital population of patients discharged with a heart-failure diagnosis was surveyed . Eighty-nine per cent of all the hospitalized patients ( n=1541 ) were 65 years old . Of these , 69 % ( n=1058 ) were treated in the medical wards which were screened . The study criteria were met by 158 patients ( 15 % ) . No visits to the nurse occurred in 23 cases among the 79 patients r and omized to the structured-care group ( 29 % ) , mainly on account of death or fatigue . The numbers of hospitalizations and hospital days did not differ between the structured-care and the usual-care groups . CONCLUSIONS Given the selection criteria and the outline of the interventions , the outpatient , nurse-monitored , symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe , chronic heart failure , mainly because of the small proportion of eligible patients and the high drop-out rate . Management of these patients would have to be more adjusted to their home situation OBJECTIVE Patients with heart failure need education and support to improve knowledge and self-care .  Shared medical groups that provide education and support have been successful in other patient population s. This study compares an advanced practice nurse-led shared medical appointment intervention in the office setting with st and ard care relative to self-care and knowledge among community-living adults with heart failure . METHODS Participants were r and omized to shared appointment and st and ard care groups  , and completed the Heart Failure Knowledge Test and Self-Care Heart Failure Index at baseline and 8 weeks . RESULTS From baseline to 8 weeks , Heart Failure Knowledge Test scores improved more for the intervention group than the control group ( F time X group = 4.90 , df = 1.21 ; P = .038 ) . There was no difference in groups ' rates of change on the total Self-Care Heart Failure Index . CONCLUSION The findings reveal improved knowledge when education and support are provided in a shared medical appointment setting . The shared medical visit model may be feasible as a way to provide patients with heart failure and their families with ongoing education and a supportive environment This pilot study tested a videotape intervention design ed to improve patient selfmanagement of heart failure ( HF ) . Content of the video series ( produced professionally under a federal grant ) is based on national , scientifically vali date d guidelines for HF home management . Outcomes tested were HF knowledge , symptom reporting , and functional status .  Participants were 10 newly diagnosed HF patients ( mean age 67 ) . After viewing the tapes , data indicated participants had a clinical ly relevant improvement in HF knowledge , and improved or maintained HF health status . None were rehospitalized during the 60-day follow-up period . One patient contacted his/her physician to report weight gain , as prompted by the videotapes . The cost data indicated that patients paid $ 177 out of pocket monthly for medications and all were low income . These results indicate the need for further testing of the videotape as a potentially cost-effective method of teaching aboutHFself-management and daily home self-monitoring Background : Self-care is an integral component of successful heart failure ( HF ) management . Engaging patients in self-care can be challenging . Methods : Fifteen patients with HF enrolled during hospitalization received a motivational intervention design ed to improve HF self-care . A mixed method , pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness . Participants received , on average , 3.0 ± 1.5 home visits ( median 3 , mode 3 , range 1 - 6 ) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling . Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinical ly significant improvement in HF self-care . Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness . Results : Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4 % of participants improved in self-care after receiving the intervention . Analysis of transcribed intervention sessions revealed themes of 1 ) communication ( reflective listening , empathy ) ; 2 ) making it fit ( acknowledging cultural beliefs , overcoming barriers and constraints , negotiating an action plan ) ; and , 3 ) bridging the transition from hospital to home ( providing information , building skills , activating support re sources ) . Conclusion : An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care , but further research is needed BACKGROUND Prior studies suggest that disease management programs may be effective in improving clinical outcomes in patients with heart failure ( HF ) . However , the use of these programs in setting s with limited sources and among diverse population is not know . Thus the present study was design ed to assess the impact of a computer-based home disease management program ( Alere DayLink HF Monitoring System [ HFMS ] ) on the clinical outcomes of Medicare beneficiaries with HF who were elderly , women , and non-white males who received the care from a community-based primary care practitioner . METHODS AND RESULTS The Heart Failure Home Care ( HFHC ) trial was a multicenter , r and omized , controlled trial of HFMS versus st and ard heart failure care ( SC : enhanced patient education , education to clinicians , and follow-up ) . The primary study end point was treatment failure , defined as a composite of cardiovascular death or rehospitalization for heart failure within 6 months of enrollment . Among patients rehospitalized for HF , length of hospital stay was also considered a primary end point . A total of 315 patients were r and omized : 160 to HFMS and 155 to SC . Although the incidence of the primary outcome was somewhat higher in the SC arm ( 28.8 % versus 21.2 % , P = .15 ) , the difference was not statistically different . The length of hospital stay was also similar in both groups . CONCLUSIONS Our study results suggest that enhanced patient education and follow-up is as successful as a sophisticated home monitoring device with an interactive program in patients with HF who are elderly , women and non-Caucasian males and receive the care from a community-based primary care practitioner Context Case management by nurses improves outcomes for patients with heart failure , but studies have targeted patients at high risk for poor outcomes because of sociodemographic or clinical factors . Whether such programs benefit low-risk patients with heart failure is unknown . Contribution Among 462 patients in 1 staff-model health maintenance organization who were hospitalized with heart failure , those r and omly assigned to nurse care management  had rates of rehospitalization and death similar to rates in those who received usual care . Implication s Care management for heart failure may offer limited benefit for patients with clinical and sociodemographic characteristics that put them at low risk for hospitalization or death . The Editors The societal and personal burden of heart failure is large and is growing apace with the aging of the population ( 1 ) . Heart failure is the largest Medicare expenditure and is the leading cause of hospitalization for persons 65 years of age or older ( 2 ) . Rates of hospital readmission within 6 months range from 25 % to 50 % ( 3 ) . Moreover , behavioral factors , such as nonadherence to diet and medications , and social factors , such as social isolation and indigence , frequently contribute to early rehospitalizations ( 3 - 4 ) . Previous studies of specialized treatment programs for heart failure have targeted clinical ly high-risk , medically underserved population s. These studies demonstrated reductions in rehospitalization for heart failure and , to a lesser extent , rehospitalization for all causes ( 4 - 6 ) . In a pilot study conducted at a single Kaiser Permanente medical center in 1994 to 1995 , we found a statistically significant reduction in rehospitalization rates during a 3-month period among low-risk patients with heart failure who received nurse care management over a 6-month period ( 7 ) . The present study evaluated nurse care management for heart failure in a low-risk population of patients selected from several medical centers in the same large health maintenance organization ( HMO ) . Methods Design This was a r and omized , controlled trial of a nurse care management system for heart failure . Patient Sample We selected patients who were hospitalized with a provisional diagnosis of heart failure from Kaiser Permanente medical centers located in San Francisco , Vallejo , Walnut Creek , Sacramento , and Roseville , California , between May 1998 and October 2000 .  Hospital-based project nurses review ed hospital charts to screen for patients with new-onset or worsening heart failure on the basis of 1 ) shortness of breath ( dyspnea at rest , including orthopnea or paroxysmal nocturnal dyspnea ) and 2 ) at least 1 corroborating clinical sign ( pulmonary congestion on examination , including rales , crackles , or wheezes ) or radiologic abnormality ( pulmonary congestion on chest radiograph ) consistent with heart failure . We excluded patients who were scheduled for coronary artery bypass or valvular surgery ; had undergone cardiac surgery in the preceding 8 weeks ; had a serum creatinine value of 13.26 mol/L ( 5 mg/dL ) or greater ; were receiving dialysis or awaiting renal transplantation ; had a history of severe pulmonary disease requiring home oxygen ; had 1 or more additional diseases that were expected to result in death within 1 year ; had cognitive mental deficits , substance abuse , or severe psychiatric disorders ; or were expected to move from the area within 1 year . We did not use measurements of left ventricular function by echocardiography , radionuclide angiography , or contrast angiography as selection criteria . Among the 59 % of patients who had left ventricular ejection fraction measured , 28 % had an ejection fraction less than 0.40 and 31 % had an ejection fraction of 0.40 or greater . Study nurses interviewed patients during hospitalization or by telephone within 2 weeks after discharge , explained the purpose of the study , and obtained written informed consent . Research staff who were not associated with delivering the intervention r and omly assigned patients to treatment conditions by using sealed assignments . Equal numbers of patients were allocated to the 2 groups in each medical center by using the Efron procedure ( 8) . Physicians were notified of r and omization assignment by letter . The institutional review boards at Stanford University and Kaiser Permanente approved the study . Baseline Data Collection Baseline data , recorded by staff nurses on st and ardized forms , included sociodemographic characteristics , self-reported illnesses , medications , and results of st and ard diagnostic studies and laboratory tests . Treatment Environment Before the study , the investigators met with the medical staffs of the 5 participating hospitals to present and discuss the research protocol , including detailed descriptions of the planned interactions between the nurse care managers and the medical staff . The medical staffs were multispecialty groups of 20 to 60 physiciansapproximately 480 physicians total . After r and omization , all patients continued to receive usual care , including instruction on diet , drug adherence , physical activity , and response to changing symptoms .  Intervention In addition to usual care , patients in the intervention group received a physician-directed , nurse-managed , home-based program for heart failure developed by the investigators ( 9 ) . Originally design ed for coronary risk factor management , this program was exp and ed to encompass heart failure . It incorporated the features of best practice design ated by Rich ( 10 ) : coordination of care across disciplines , patient and caregiver education , enhancement of self-management skills , effective follow-up , and guidelines -based medications for heart failure . Our system also incorporated the principles of heart failure management developed by the Cardiovascular Nursing Council of the American Heart Association ( 11 ) . The st and ardized , telephone-mediated intervention included the following elements : initial educational session , including a videotape ; baseline telephone counseling session ; nurse-initiated follow-up telephone contacts ; pharmacologic management ; and nurse-initiated communication with physicians . The initial 1-hour educational session with a nurse occurred in the patient 's medical center . Patients received printed educational material s , including methods for self-monitoring of symptoms , body weight , and medications ; a dietary management workbook ; food-frequency question naires ; and instructions on how to access emergency care in case symptoms abruptly worsened . Patients viewed a videotape portraying the treatment process . Two experienced Stanford-based nurse care managers provided a 45-minute baseline telephone counseling session within 1 week of r and omization ; subsequent nurse contacts were tailored to the needs of the individual patients . Nurse-initiated follow-up telephone contacts with patients during daytime weekday hours were scheduled at weekly intervals for 6 weeks ; biweekly for 8 weeks ; monthly for 3 months ; bimonthly for 6 months ; and as needed to monitor patients ' medications , laboratory assessment s , symptoms , and other medical problems . We based pharmacologic management for heart failure on published treatment guidelines ( 12 , 13 ) . The nurse care managers obtained permission from physicians to initiate and regulate pharmacologic therapy for heart failure according to study protocol . Nurse-initiated communication with physicians about patients ' current medical status was maintained and specific management problems were addressed . Nurse care managers spent an average of 9 hours per patient coordinating the treatment plan with patients and physicians during the first year . The intervention did not include consultation with social services to facilitate discharge planning or home visits after discharge . Measurement Research staff who were not associated with , and were blinded to , the intervention conditions measured health outcomes at 12 months . On the basis of review of the Kaiser Permanente medical records , project nurses used st and ardized forms to record the cause , number , and duration of hospitalizations and emergency department visits during the 12-month follow-up period . Kaiser Permanente provided more than 90 % of all care . Two cardiologists who were not associated with implementing the intervention review ed medical records on deaths , rehospitalizations , and emergency department visits to determine whether these events were primarily due to heart failure or due to other causes . They did not use discharge diagnoses recorded in the medical record to make these judgments . Rehospitalizations and emergency department visits were classified as either due to heart failure or due to other causes ; the latter were classified as cardiac or noncardiac . Outcomes The primary outcome of the study was the time to first rehospitalization for heart failure or for any cause . In our analysis , we treated deaths occurring before rehospitalization as censored data . However , analysis in which we classified deaths occurring before rehospitalization as outcome events result ed in similar conclusions , primarily because most observed deaths occurred after a rehospitalization . Secondary outcomes were the time to a composite outcome of death , rehospitalization , or emergency department visits for cardiac cause or for any cause , the proportion of patients receiving recommended pharmacotherapy , and the rate of outpatient clinic and emergency department visits . We based the study 's power on a proposed reduction in the risk for rehospitalization for heart failure from 21 % to 13 % , corresponding to a number needed to treat for benefit of 12.5 . We expected that the actual number needed to treat for benefit would be less than 12.5 . Statistical Analysis We evaluated the effect of care management on rehospitalization rates by using KaplanMeier survival curves and Cox proportional hazards regression models . We compared nominal variables by using chi-square tests , ordered variables by ABSTRACT This study examines the effects of a home health intervention design ed to st and ardize nursing care , strengthen nurses ' support for patient self-management and yield better CHF patient outcomes . Participants were 371 Medicare CHF patients served by 205 nurses r and omized to intervention and control groups in a large urban home health care agency ( HHA ) . The intervention consisted of an evidence -based nursing protocol , patient self-care guide , and training to improve nurses ' teaching and support skills . Outcome measures included home care , physician and emergency department ( ED ) use , hospital admission , condition-specific quality of life ( QoL ) , satisfaction with home care services and survival at 90 days . The intervention was associated with a marginally significant reduction in the volume of skilled nursing visits ( p = .074 ) , and a reduction variation in the typical number of visits provided ( p < .05 ) , without a significant increase in physician or ED use or patient mortality . Hypothesized improvement in other outcomes did not occur Background : Improved self-care behaviour is a goal in educational programmes for patients with heart failure , especially in regard to daily self-weighing and salt and fluid restriction . Aims : The objectives of the present study were to : ( 1 ) describe self-care with special regard to daily self-weighing and salt and fluid restriction in patients with heart failure in primary health care , during one year of monthly telephone follow-up after a single session education , ( 2 ) to describe gender differences in regard to self-care and ( 3 ) to investigate if self-care was associated with health-related quality of life . Methods : The present analysis is a subgroup analysis of a larger r and omised trial . After one intensive educational session , a primary health care nurse evaluated 60 patients ( mean age 79 years , 52 % males , 60 % in New York Heart Association class III – IV ) by monthly telephone follow-up during 12 months . Results : The intervention had no effect on quality of life measured by EuroQol 5D and no significant associations were found between quality of life and self-care behaviour . Self-care behaviour measured by The European Self-care Behaviour Scale remained unchanged throughout the study period . No significant gender differences were shown but women had a tendency to improve adherence to daily weight control between 3- and 12 months . Conclusion : The self-care behaviour and quality of life in patients with heart failure did not change during one year of monthly telephone follow-up after a single session education and this indicates a need for more extensive interventions to obtain improved self-care behaviour in these patients Patient self-management is a critical determinant of heart failure ( HF ) outcomes , yet patients with HF are often frail and socially isolated , factors that may limit their ability to manage self-care and access clinic-based services . Mobilizing peer support among HF patients is a promising strategy to improve self-management support . In this pilot , the authors evaluated the feasibility and acceptability of an interactive voice response (IVR)-based platform to facilitate telephone peer support among older adults with HF . Participants completed a baseline survey , were offered a 3-hour training session in peer communication skills , and were paired with another patient who had HF . Participants were asked to contact their partner weekly using a toll-free IVR phone system that protected their anonymity and provided automated reminders if contacts were not made . Times and duration of participants ' telephone contacts were monitored and recorded . After the 7-week intervention , participants completed surveys and brief face-to-face interviews . The authors found high levels of use and satisfaction and improvements in depressive symptoms among the 20 pilot study participants . An IVR peer-support intervention is feasible , is acceptable to patients , and may have positive effects on patients '  HF social support and health outcomes , in conjunction with structured health system support , that warrant more rigorous evaluation in a r and omized trial BACKGROUND Disease management programmes for patients with heart failure have improving the quality -of-life ( QOL ) of patients with heart failure . METHODS Patients attending the heart failure clinic were r and omized into 2 groups of 25 patients each . The control group was managed in the heart failure clinic and the intervention group underwent the following additional interventions : ( i ) interactive sessions with the patient and spouse informing them about the disease , drugs , and self-management of fluid intake and diuretic dose ; ( ii ) a telephonic helpline was established and regular telephone calls made to reinforce the information and modify drug dosages . The QOL was assessed using the Kansas City Cardiomyopathy question naire . Functional capacity was assessed by the 6-minute walk test . Continuous variables were compared with the Student t-test ( paired or unpaired ) . RESULTS There was significant improvement in the QOL and functional capacity of patients in the intervention group compared with controls over a 6-month period . The mean ( SD ) QOL scores in the intervention group improved from 60.0 ( 23.6 ) to 76.3 ( 17.3 ) but did not change significantly in the control group ( 62.2 [ 22.6 ] to 63.4 [ 21.9 ] ) . There was a similar improvement in the functional capacity measured by the 6-minute walk test in the intervention group ( from 202.2 [ 81.5 ] to 238.1 [ 100.9 ] metres , p < 0.05 ) but not in the control group ( 193.8 [ 81.5 ] to 179.7 [ 112.0 ] metres ) . In the intervention group , the use of beta-blockers and angiotensin-converting enzyme inhibitors was similar but in the intervention group patients were placed on higher doses . There was no significant difference in the number of emergency room visits or admissions in either group . For every 20 patients in the intervention group , 14 patients improved by 1 functional class while in the control group this was observed in only 3 patients for every 20 treated . CONCLUSION This study demonstrates that in the setting of a developing country , improvement in QOL by intensive management of heart failure patients through a heart failure programme with telephonic reinforcement and a helpline is greater than that usually achieved with drug therapy in a routine heart failure clinic BACKGROUND A single home-based intervention ( HBI ) applied immediately after hospital discharge in a cohort of " high-risk " patients with congestive heart failure has been shown to decrease numbers of unplanned readmissions plus out-of-hospital deaths during a period of 6 months . The duration of this beneficial effect remains uncertain . METHODS Hospitalized patients with congestive heart failure who had been r and omly assigned to receive either usual care ( n=48 ) or HBI 1 week after discharge ( n=49 ) were subject to an extended follow-up of 18 months . The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths . Secondary end points included total hospital stay , frequency of multiple readmissions , cost of hospital-based care , and total mortality . RESULTS During 18-month follow-up , HBI patients had fewer unplanned readmissions ( 64 vs 125 ; P=.02 ) and out-of-hospital deaths ( 2 vs 9 ; P=.02 ) , representing 1.4+/-1.3 vs 2.7+/-2.8 events per HBI and usual-care patient , respectively ( P=.03 ) . The HBI patients also had fewer days of hospitalization ( 2.5+/-2.7 vs 4.5+/-4.8 per patient ; P=.004 ) and , once readmitted , were less likely to experience 4 or more readmissions ( 3/31 vs 12/38 ; P=.03 ) . Hospital-based costs were significantly lower among HBI patients ( Aust $ 5100 vs Aust $ 10600 per patient ; P=.02 ) . Unplanned readmission was positively correlated with 14 days or more of unplanned readmission in the 6 months before study entry ( odds ratio [ OR ] , 5.4 ; P=.006 ) . Positive correlates of death were ( 1 ) non-English speaking ( OR , 4.9 ; P=.008 ) , ( 2 ) 14 days or more of unplanned readmission in the 6 months before study entry ( OR , 4.9 ; P=.008 ) , and ( 3 ) left ventricular ejection fraction of 40 % or less ( OR , 3.0 ; P=.03 ) ; conversely , assignment to HBI was a negative correlate ( OR , 0.3 ; P=.02 ) . CONCLUSIONS In this controlled study , among a cohort of high-risk patients with congestive heart failure , beneficial effects of a postdischarge HBI were sustained for at least 18 months , with a significant reduction in unplanned readmissions , total hospital stay , hospital-based costs , and mortality ABSTRACT This trial compared 3  post-hospitalization nursing care models for reducing  congestive heart failure ( CHF ) readmission charges during 180-days of follow-up . Subjects received in-person visits at baseline and 60 days plus 1 of 3 care modalities in the interim : ( a ) video-based home telecare ; ( b ) telephone calls ; and ( c ) usual care .  CHF-related read-mission charges were > 80 % lower in the telenursing groups compared to usual care , and these groups also had significantly fewer CHF-related emergency visits . In-person visits were more than 3 times longer than telenursing visits ( p < 0.0001 ) , only partially due to added travel time . Patient self-care adherence , medications , health status , and satisfaction did not significantly differ between groups . Telenursing can reduce CHF hospitalizations and allow increased frequency of communication with patients BACKGROUND Self-monitoring by heart failure ( HF ) patients of worsening symptoms caused by fluid overload is a cornerstone of HF care . Disease management has improved outcomes in HF ; however , these re source -intensive programs are limited to urban centers and are generally unavailable in rural or limited health care access areas . This pilot study sought to determine whether a simplified education program focused on a single component of disease management ( symptom recognition and management of fluid weight ) could improve knowledge , patient-reported self-care behavior , and HF severity in a rural setting . METHODS This r and omized clinical trial enrolled 36 rural HF patients into an intervention or control group . The intervention group received a simplified education program with a follow-up phone call focusing on symptom management delivered by a non-cardiac-trained nurse .  Patient knowledge , self-care behaviors , and HF severity ( B-natriuretic peptide [ BNP ] ) were measured at enrollment and at 3 months . RESULTS The sample was primarily white men and married with a mean age of 71 years and ejection fraction of 47 % . There were no differences between groups in knowledge , self-care behaviors and BNP at baseline ; however , knowledge and self-care behavior related to daily weights improved significantly at 3 months in the intervention group ( P = .01 and .03 , respectively ) . Although the changes in mean BNP at 3 months were in the hypothesized direction , the difference between the 2 groups was not significant . CONCLUSIONS A simplified education program design ed for use in re source scarce setting s improves knowledge and patient-reported self-care behaviors . These findings are important in providing care to patients with HF in limited access setting s but should be studied for longer periods in more heterogeneous population Peer support has been used effectively in a variety of patient population s , but its effectiveness in improving outcomes in persons with chronic heart failure has not been explored . We trained 9 persons with heart failure to mentor other heart failure patients  and tested the effectiveness of this approach in a r and omized controlled clinical trial . A low proportion ( 37 % ) of the eligible population of hospitalized patients agreed to participate . At the end of the 3-month trial , there was significantly higher heart failure self-care in the intervention group ( P < .05 ) . The only difference in social support was a significant decline in perceived support reciprocity in the intervention group ( F = 5.94 , P = .004 ) . No significant group differences in heart failure readmissions , length of stay , or cost were evident at 90-days , although the heart failure readmission rate was 96 % higher in the intervention group when compared to that in the control group . The reasons for low overall enrollment and high readmission rates in the intervention group require further study . Including additional self-care education by a professional , rather than leaving all the education to the mentor , could strengthen the peer support intervention trialed in this study . Small group meetings may be less intrusive and more desirable for this patient population The European Heart Failure Self-care Behaviour Scale ( EHFScBS ) has been developed for assessing patients ' self-care level . We used it to assess our patients ' self-care progress after a medium-term period of nurse education intervention . Patients and method : We prospect ively studied 151 patients ( 111 men and 40 women , mean age 65.4 ± 11.9 years ) . All patients were evaluated twice with the EHFScBS : during the first visit to the Unit and after 1 year of nurse educational intervention . Results : Mean score obtained by our patients in the initial evaluation was 24.8 ± 7.6 . In the second evaluation patients showed a significant ( p < 0.001 ) improvement in self-care behaviour ( mean score 19.9 ± 5.7 ) . Analyzing item by item of the scale , patients show improvement in all items except in four : “ If I am short of breath , I take it easy ” , “ I take a rest during the day ” , “ I eat a low salt diet ” and “ I take my medication as prescribed ” . Conclusions : Improvement in self-care behaviour , assessed with the EHFScBS , was achieved with nurse educational intervention in patients without previous heart failure education . However , in our population , this improvement was not obtained in one important aspect such is low salt diet compliance , although punctuation in this item was quite acceptable already initially BACKGROUND Both r and omized and nonr and omized controlled studies have linked congestive heart failure ( CHF ) case management ( CM ) to decreased readmissions and improved outcomes in mostly homogeneous setting s. The objective of this r and omized controlled trial was to test the effect of CHF CM on the 90-day readmission rate in a more heterogeneous setting . METHODS A total of 287 patients admitted to the hospital with the primary or secondary diagnosis of CHF , left ventricular dysfunction of less than 40 % , or radiologic evidence of pulmonary edema for which they underwent diuresis were r and omized . The intervention consisted of 4 major components : early discharge planning , patient and family CHF education , 12 weeks of telephone follow-up , and promotion of optimal CHF medications . RESULTS The 90-day readmission rates were equal for the CM and usual care groups ( 37 % ) . Total inpatient and outpatient median costs and readmission median cost were reduced 14 % and 26 % , respectively , for the intervention group . Patients in the CM group were more likely to be taking CHF medication at target doses , but dosages did not increase significantly throughout 12 weeks . Although both groups took their medications as prescribed equally well , the rest of the adherence to treatment plan was significantly better in the CM group . Subgroup analysis of patients who lived locally and saw a cardiologist showed a significant decrease in CHF readmissions for the intervention group ( P = .03 ) . CONCLUSIONS These results suggest several limitations to the generalizability of the CHF CM-improved outcome link in a heterogeneous setting . One explanation is that the lack of coordinated system supports and varied accessibility to care in an extended , nonnetworked physician setting limits the effectiveness of the CM This study assessed the feasibility of a telephonic nurse double-disease management program ( DDMP ) for patients with depression and congestive heart failure . Thirty-five patients with depression and congestive heart failure were entered into a novel DDMP modeled after Wagner 's chronic illness care model and implemented as part of a 13-month Breakthrough Series Collaborative administered by the Institute of Healthcare Improvement . Twenty-four patients remained in the program long enough to complete at least one follow-up assessment ( ie , 6 weeks or longer ) . Patients were entered into the program based on depression severity scores from either the interactive voice response ( IVR ) version of the Hospital Anxiety and Depression Scale ( HADS ) or the self-administered ( or telephonic ) Patient Health Question naire ( PHQ ) . Because use of the IVR version of the HADS was eliminated after several weeks into the program ( because of poor patient acceptance ) , 19 patients had both entry and follow-up scores on the same instrument ( PHQ ) . Depression " response " was defined as a 50 % improvement in PHQ score . Mixed models regression was used to test the statistical significance of change in PHQ scores over time . Patient and clinician reports were obtained to evaluate program acceptability and satisfaction . Eighty-two percent of patients ( n = 11 ) with Major Depressive Disorder ( MDD ) responded , and 75 % of patients ( n = 8) with " other depression " ( PHQ score < 10 ) responded . Mean change in PHQ scores for the sample as a whole improved significantly over the 24 weeks of the program ( p < 0.0003 ) , as well as for those with major depression and other depression considered separately ( p < 0.01 for both ) . In some patients who refused medication , depression seemed to respond to self-management support interventions of the care manager . Based on patient acceptance and clinicians ' reports , the program appeared feasible and possibly effective . DDMP appears feasible and possibly effective . Future clinical trials are warranted BACKGROUND Congestive heart failure is the most common indication for admission to the hospital among older adults . Behavioral factors , such as poor compliance with treatment , frequently contribute to exacerbations of heart failure , a fact suggesting that many admissions could be prevented . METHODS We conducted a prospect i ve , r and omized trial of the effect of a nurse-directed , multidisciplinary intervention on rates of readmission within 90 days of hospital discharge , quality of life , and costs of care for high-risk patients 70 years of age or older who were hospitalized with congestive heart failure . The intervention consisted of comprehensive education of the patient and family , a prescribed diet , social-service consultation and planning for an early discharge , a review of medications , and intensive follow-up . RESULTS Survival for 90 days without readmission , the primary outcome measure , was achieved in 91 of the 142 patients in the treatment group , as compared with 75 of the 140 patients in the control group , who received conventional care ( P = 0.09 ) . There were 94 readmissions in the control group and 53 in the treatment group ( risk ratio , 0.56 ; P = 0.02 ) . The number of readmissions for heart failure was reduced by 56.2 percent in the treatment group ( 54 vs. 24 , P = 0.04 ) , whereas the number of readmissions for other causes was reduced by 28.5 percent ( 40 vs. 29 , P not significant ) . In the control group , 23 patients ( 16.4 percent ) had more than one readmission , as compared with 9 patients ( 6.3 percent ) in the treatment group ( risk ratio , 0.39 ; P = 0.01 ) . In a subgroup of 126 patients , quality -of-life scores at 90 days improved more from base line for patients in the treatment group ( P = 0.001 ) . Because of the reduction in hospital admissions , the overall cost of care was $ 460 less per patient in the treatment group . CONCLUSIONS A nurse-directed , multidisciplinary intervention can improve quality of life and reduce hospital use and medical costs for elderly patients with congestive heart failure Patients with a diagnosis of heart failure , registered at the study practice , were recruited into the study . First , they had a cardiologist 's assessment . They were then r and omised into telemonitored patients who measured pulse , BP , weight and video consulted , and controls AIMS The ' Chronic Disease Self-Management Programme ' ( CDSMP ) emphasizes patients ' responsibility for the day-to-day management of their condition(s ) and has shown favourable effects on health behaviour and healthcare utilization among various groups of patients with chronic conditions . However , the effects of the CDSMP among congestive heart failure ( CHF ) patients are unknown . We therefore aim ed to assess the effects of the CDSMP on health behaviour and healthcare utilization in patients with CHF . METHODS AND RESULTS This r and omized , controlled trial with 12 months of follow-up included 317 CHF patients with a slight to marked limitation of physical activity . Control patients ( n = 131 ) received usual care , consisting of regular checkups at an outpatient clinic . Intervention group patients ( n = 186 ) received usual care and participated in a 6-week self-management group programme .  Favourable effects on walking for exercise and other physical activities such as aerobic , stretching , and strength exercises , sports , and gardening were reported in the intervention group immediately after completion of the programme . The effect of the programme on other physical activities extended to 6 months of follow-up . No favourable effects were found for the other outcomes . CONCLUSION The CDSMP significantly improved physical activity  among CHF patients for up to 6 months after the end of the programme ; however , it did not affect other health behaviour outcomes or healthcare utilization AIM The aim of this trial was to prospect ively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality , morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge . METHODS A total of 106 patients were r and omly assigned to either follow-up at a nurse-led heart failure clinic or to usual care . The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses , delegated the responsibility for making protocol -led changes in medications . The first follow-up visit was 2 - 3 weeks after discharge . During the visit the nurse evaluated the heart failure status and the treatment , gave education about heart failure and social support to the patient and his family . RESULTS There were fewer patients with events ( death or admission ) after 12 months in the intervention group compared to the control group ( 29 vs 40 , p=0.03 ) and fewer deaths after 12 months ( 7 vs 20 , p=0.005 ) . The intervention group had fewer admissions ( 33 vs 56 , p=0.047 ) and days in hospital ( 350 vs 592 , p=0.045 ) during the first 3 months . After 12 months the intervention was associated with a 55 % decrease in admissions/patient/month ( 0.18 vs 0.40 , p=0.06 ) and fewer days in hospital/patient/month ( 1.4 vs 3.9 , p=0.02 ) . The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group ( p=0.02 and p=0.01 ) . CONCLUSIONS Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events , readmissions and days in hospital BACKGROUND In the last few years different approaches based on comprehensive patient care and close surveillance by multidisciplinary teams have shown promising results in heart failure . However , current evidence mainly derives from small and often nonr and omized studies performed at a single center , with selected population s , using dissimilar and complex strategies . We design ed a large r and omized study to test the hypothesis that a single program , based on a central ized telephone intervention performed by trained nurses , could reduce morbidity and mortality in chronic heart failure . METHODS The R and omized Trial of Telephone Intervention in Chronic Heart Failure ( DIAL ) is a r and omized , controlled , open trial design ed to compare frequent telephone follow-up intervention versus control . We enrolled 1518 patients with stable chronic heart failure and optimal treatment from 51 centers in Argentina . DIAL trial intervention strategy is based on frequent telephone follow-up provided by nurses trained in heart failure and performed from a single surveillance center , assuring a homogeneous and high quality intervention . The primary objective is to determine the effect of the intervention as compared with the usual follow-up on the combined endpoint of all-cause mortality or hospitalization for worsening heart failure . The objectives of the intervention are  education , counseling , and monitoring to enhance self-control mechanisms , timely medical visits , diet , and drug therapy compliance . Telephone call frequency was determined according to preestablished criteria of clinical status severity assessed at each phone contact . The study ended in August 2002 . CONCLUSION The results of this study may provide information about mortality , hospitalizations , and quality of life contributing to set st and ards for management programs in the current treatment of chronic heart failure Web-based communication has been reported as a feasible management tool for heart failure ( HF ) patients and has also been documented to positively impact quality of life ( QOL ) . The feasibility and effectiveness of a Web-based educational and HF management program among older HF patients ( 60 years and older ) , however , have not been previously explored . Therefore , a prospect i ve study was conducted . QOL ( physical and mental health ) and perceived control ( PC ) scores of 40 participants were measured ( baseline and 3 months ) and retrospectively compared with an age- and sex-matched control group of 40 patients receiving HF care as usual .  Between-group differences over time were statistically significant in the QOL mental health component and PC scores . The authors ' findings demonstrate the beneficial effects of a Web-based program on QOL and PC in older patients with HF . This approach may be potentially beneficial in delivering educational and behavioral support to this high-risk group in ways that are affordable and accessible OBJECTIVE To evaluate the effects of a single-session , interactive computer-based educational program on knowledge , compliance and quality of life in heart failure patients with special emphasis on gender differences . METHODS One hundred and fifty-four patients , mean age 70 years , from five heart failure clinics were r and omised to either receiving only st and ard education ( n=72 ) or st and ard education and additional computer-based education ( n=82 ) . RESULTS Knowledge was increased in both groups after 1 month with a trend towards higher knowledge ( P=0.07 ) in the computer-based group . The increase in knowledge was significantly higher in the computer-based group after 6 months ( P=0.03 ) . No differences were found between the groups with regard to compliance with treatment and self-care or quality of life . The women had significantly lower quality of life and did not improve after 6 months as the men did ( P=0.0001 ) . CONCLUSION Computer-based education gave increased knowledge about heart failure . PRACTICE IMPLICATION S Computers can be a useful tool in heart failure education , but to improve compliance a single-session educational intervention is not sufficient . Gender differences in learning and quality of life should be further evaluated BACKGROUND Telemonitoring , the use of communication technology to monitor clinical status , is gaining attention as a strategy to improve the care of patients with heart failure . A system of frequent monitoring could alert clinicians to early heart failure decompensation , providing the opportunity for intervention before patients become severely ill and require hospitalization . Moreover , patients ' participation in a daily monitoring program could have a favorable effect on their health behaviors . The literature on telemonitoring for heart failure , however , is quite limited . METHODS AND MATERIAL S Telemonitoring to Improve Heart Failure Outcomes ( Tele-HF ) is a r and omized , controlled , trial design ed to compare an automated , daily symptom , and self-reported weight monitoring intervention with usual care in reducing ( all-cause ) hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure . The intervention will be implemented and all outcomes will be assessed over a 6-month period . The purpose of the intervention is to collect information about symptoms , clinical status and weight and to engage participants in their own self-care .  Participants are recruited from general cardiology , heart failure specialty , and primary care practice s across the United States . CONCLUSIONS The results of this study may inform future policy decisions regarding implementation of telemonitoring in treatment of heart failure BACKGROUND Heart failure ( HF ) is increasing in prevalence and is associated with prolonged morbidity , repeat hospitalizations , and high costs . Drug therapies and lifestyle changes can reduce hospitalizations , but nonadherence is high , ranging from 30 % to 80 % . There is an urgent need to identify cost-effective ways to improve adherence and reduce hospitalizations . TRIAL DESIGN The Heart Failure Adherence and Retention Trial ( HART ) evaluated the benefit of patient self-management ( SM ) skills training in combination with HF education , over HF education alone , on the composite end points of death/HF hospitalizations and death/all-cause hospitalizations in patients with mild to moderate systolic or diastolic dysfunction . Secondary end points included progression of HF , quality of life , adherence to drug and lifestyle regimens , and psychosocial function . The HART cohort was composed of 902 patients including 47 % women , 40 % minorities , and 23 % with diastolic dysfunction . After a baseline examination , patients were r and omized to SM or education control , received 18 treatment contacts over 1 year , annual follow-ups , and 3-month phone calls to assess primary end points . Self-management treatment was conducted in small groups and aim ed to activate the patient to implement HF education through training in problem-solving and 5 SM skills . The education control received HF education in the mail followed by a phone call to check comprehension . CONCLUSIONS The significance of HART lies in its ability to determine the clinical value of activating the patient to collaborate in his or her care . Support for the trial hypotheses would encourage interdisciplinary HF treatment , drawing on an evidence base not only from medicine but also from behavioral medicine BACKGROUND Multidisciplinary heart failure programs including patient education and self-management strategies such as daily recording of body weight and use of a patient diary decrease hospital readmissions and improve quality of life . However , the degree of uptake of individual components of these programs and their contribution to patient benefit are uncertain . METHODS Patients with heart failure admitted to Auckl and Hospital were r and omised into the management or usual care groups of the Auckl and heart failure management study ( AHFMS ) . Patients in the management group were given a heart failure diary for the recording of daily weights , attended a heart failure clinic and were encouraged to attend three education sessions . Patients in the usual care group received routine clinical care , mainly from general practitioners . Patients were followed to 12 months . This study investigated the uptake of self-management by assessing diary use and self-weighing behaviour in the group receiving the heart failure intervention , and compared the level of knowledge of heart failure self-management of the management group to the control group after 12 months . RESULTS Of the 197 patients in the AHFMS , 100 patients were included in the management group  and received a diary and education about heart failure self-management including  monitoring weight daily .  Of these patients , 76 patients used the diary  . These patients were on more medication ; were more likely to attend the education sessions , heart failure clinic , and primary care , and had a lower mortality rate over the course of the study . Variables independently associated with use of the diary included less severe symptoms ( OR 15 , 95 % confidence intervals 1.7 , 144 ) , frequent attendance at the heart failure clinic ( OR 15 , 95 % CI 3 , 78 ) and attendance at an education session ( OR 8 , 95 % CI 1.5 , 42 ) . Of the 76 patients who used the diary , 51 weighed themselves regularly . More of these patients owned scales at home ; they were also more likely to attend the education sessions , and experienced fewer hospital admissions than those patients who did not weigh themselves regularly . Variables independently associated with regular self-weighing included the presence of scales at home ( OR 6.3 , 95 % CI 1.7 , 14.1 ) , left ventricular ejection fraction > 30 % ( OR 4.3 , 95 % CI 1.1 , 17.5 ) , and attendance at the education session(s ) ( OR 6.3 , 95 % CI 1.7 , 14.1 ) . Patients in the management group exhibited higher levels of knowledge at 12 months of follow-up and were more likely to monitor their condition using daily weighing , compared to the control group . CONCLUSIONS At 12 months of follow-up , implementation of self-management strategies including daily weight monitoring and level of education on self-management was significantly higher in the management group than the control group . For the patients in the management group , not using the diary or inability to perform daily weighing were associated with less frequent attendance at the heart failure clinic and education sessions and poorer health outcomes . In this study , attendance at the education sessions was associated with the adoption of self-management , underlining the importance of education in multidisciplinary heart failure programmes . Self-weighing could be increased by provision of scales to all patients . The subset of patients who did not adopt self-management strategies in this study were at high risk of death or readmission OBJECTIVE The goal of this study was to determine the effects of a supportive educational nursing intervention on self-care abilities , self-care behavior , and quality of life of patients with advanced heart failure . DESIGN The study design was an experimental , r and om assignment . SETTING The study was located at the University Hospital in Maastricht , The Netherl and s. PATIENTS The study included 179 patients ( mean age 73 years , 58 % men , New York Heart Association classification III and IV ) admitted to a university hospital with symptoms of heart failure . OUTCOME MEASURES Outcome measures included self-care abilities ( Appraisal of Self-care Agency Scale ) , self-care behavior ( Heart Failure Self-care Behavior Scale ) , 3 dimensions of quality of life ( functional capabilities , symptoms , and psychosocial adjustment to illness ) , and overall well-being ( Cantril 's ladder of life ) . INTERVENTION The intervention patients received systematic education and support by a nurse in the hospital and at home . Control patients received routine care . RESULTS Self-care abilities did not change as a result of the intervention , but the self-care behavior in the intervention group was higher than the self-care behavior in the control group during follow-up . The effect of the supportive educational intervention on quality of life was limited . The 3 dimensions of quality of life improved after hospitalization in both groups , with no differences between intervention and control group as measured at each follow-up measurement . However , there was a trend indicating differences between the 2 groups in decrease in symptom frequency and symptom distress during the 9 months of follow-up . CONCLUSION A supportive educational nursing intervention is effective in improving self-care behavior in patients with advanced ( New York Heart Association class III-IV ) heart failure ; however , a more intensive intervention is needed to show effectiveness in improving quality of life BACKGROUND Patients with chronic heart failure have a reduced quality of life due in part to their limited range of physical activity and independence . OBJECTIVES The paper examines whether a physical activity ' lifestyle ' intervention , based on motivational interviewing , will improve quality of life at five months from baseline , compared with conventional treatment . METHODS Sixty older patients with chronic heart failure were r and omly assigned to either a ' st and ard care ' , ' motivational interviewing ' or ' both ' treatment groups for five months in 2002 . The primary outcome measures were the Medical Outcomes Short Form-36 Health Survey , the disease-specific Minnesota Living with Heart Failure question naire and the Motivation Readiness for Physical Activity scale . RESULTS There were non-significant differences between the groups at baseline for age , coronary risk factors , severity of chronic heart failure , ejection fraction , specific laboratory tests , length of hospitalisation , medication and social support . Following treatment there was a significant increase ( p<0.05 ) for three of the dimensions of the health survey in the ' motivational interviewing ' group . All groups improved their scores ( p<0.05 ) on the heart failure question naire . Over the five month period there was a general trend towards improvements in self-efficacy and motivation scores . CONCLUSIONS This study has demonstrated that a ' motivational interviewing ' intervention , incorporating behaviour change principles to promote physical activity , is effective in increasing selected aspects of a general quality of life question naire and a disease-specific quality of life question naire . Thus a ' motivational interviewing ' approach is a viable option compared with traditional exercise programming . It is important to test these motivational interviewing interventions more widely , especially to match individuals to treatments
BACKGROUND Heart failure is a common chronic disease that is one of the leading causes of hospitalisations in many countries around the world .
Poor compliance with recommended self-care behaviours , for example managing medication and diet regimes , rather than the deterioration of the cardiac condition , have contributed to a significant proportion of heart failure exacerbations .
Patients with heart failure can benefit from interventions that aim to increase their knowledge of the disease and support them in managing their care .
There is a need , however , to determine which interventions , if any , are more effective in achieving the aims of self-care .
OBJECTIVE This review examined the evidence to answer the question : What are the most effective interventions for helping adults with heart failure comply with therapy and enhance self care behaviours ?