Discussion
depression, heart failure, insecurity, anxiety
HEART FAILURE, SECONDARY
No statistically significant improvement from the intervention was found for the six months change on Global AFEQT score, compared to standard care. Additionally, confidence intervals for the estimates were wide, giving a large uncertainty and making interpretation about the size of the difference hard. Adjustments for baseline values did result in a larger estimated difference, however the uncertainty for this estimate was even larger than the uncertainty for the unadjusted estimate and thereby not making interpretation of the result any easier. Because of this large uncertainty a possible relevant effect may be present, but it is not possible to answer from the data in this study.For secondary outcomes only ICE-FPSQ Cognitive, emotional and total score showed a significant difference and reasonable thin confidence intervals, indicating a possible difference might be present. This would have to be confirmed in another study. However, there is no consensus in literature og what constitutes a relevant change [Supportive of the possible future use of family-focused nursing as an integrated part of AF care and treatment, this intervention was shown to be feasible in an out-patient clinical setting even during the COVID-19 pandemic. Notably, approximately half of the eligible and approached patients and their families accepted participation in the study.According to Dorian et al., 18.9 increase in the global AFEQT score is considered a moderate improvement and 27.8 a large improvement [Results similar results to ours were observed in a randomised controlled study investigating the effect of nursing interventions targeting patients with heart failure and their family members; due to lack of power, this study detected no significant effect on HRQOL, anxiety or depression [Even though none of the patient in the control or intervention group had high scores on the HADS at baseline, we observed a decrease in anxiety and depression scores in both groups though the intervention group experienced more positive (50%) changes reflected in the AFEQT scores, which could be a clinical relevant change on HADS [Whether our results should pave the way for a more systematic use of family-focused intervention may be discussed with a focus on the evaluation method and the study context. The present study can be categorised as a complex intervention within the context of the healthcare system where multiple factors may influence outcomes, actions and behaviour of patients, families and health professionals [Other interventions targeting HRQoL in AF patients have used AFEQT to measure quality of life [Another relevant aspect to consider is that the family-focused intervention may potentially have affected other patient-reported outcomes than those we chose, e.g., emotional wellbeing and self-efficacy, which is the individual’s belief in his or her capacity to manage specific tasks and feeling self-confident [Nevertheless, we provided reflective space for expressing illness beliefs and insecurity among patients and their family members. The present study focused on patient-related outcomes. However, it could also have been designed to measure family member outcomes as well. Petursdottir et al. showed that a family therapeutic intervention yielded increased perceived support, decreased stress and reduced caregiving demands among the family members [