Heart failure patients benefit from nurse-led intervention

Nov 6 2007

Heart failure patients are more likely to comply with important non-medication interventions, such as fluid and salt restrictions and regular weighing, when they have intensive support from a heart failure nurse and multidisciplinary team than if they do not, researchers reported at the American Heart Association's Scientific Sessions 2007.

Although previous studies have examined medication adherence among heart failure patients, limited information is available on these patients' adherence to the complex nonpharmacologic regimen of sodium restriction, fluid restriction and daily weighing.

“We examined the effect of education and counseling by heart failure nurses on adherence to nonpharmacologic treatments because these are so important to the patients' survival,” said Martje H.L. van der Wal, R.N., Ph.D., study lead author and a cardiology nurse researcher at the department of cardiology of the University Medical Center Groningen, University of Groningen, in The Netherlands.

Researchers referred to the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) study, representing data from 17 Dutch hospitals and 1,023 heart failure patients (average age 71).

Patients were assigned to three groups:

• The first group (the controls) received usual care, which included regular visits to their cardiologist during the 18-month trial.

• The second group (basic support) received basic education and counseling from a specialized heart failure nurse. Patients in this group visited the heart failure nurse every three months at the heart failure clinic and could call the nurse with questions or if their heart failure worsened.

• The third group (intensive support) received intensive education and counseling from a heart failure nurse and had at least monthly contact with the nurse, including one or more home visits. Patients in this group also received advice from a dietician, physiotherapist and social worker.

On five occasions during the study, all patients completed questionnaires addressing adherence, knowledge of heart failure and depressive symptoms.

The study found that heart failure nurses make a positive impact on these patients' adherence to nonpharmacologic treatment. While basic support improved compliance in all three areas, intensive support led to more significant improvement in daily weighing, which is vital for monitoring the condition, van der Wal said.

During the 18 months of the study:

• 90 percent of patients in the support groups adhered to their fluid restriction, compared to 67 percent at the study's start, while there was no improvement in the control group;

• 90 percent of both support group patients adhered to heart failure diet restrictions versus 75 percent before the study;

• 79 percent in the basic support group and 89 percent in the intensive support group weighed themselves regularly versus 56 percent of patients in the control group.

More patients in the support groups were aware of important symptoms of worsening heart failure and when to call health care providers.

“Support from a heart failure nurse can help patients to cope with the difficult and complex regimen they have for their heart failure and to incorporate the regimen into their daily lives,” van der Wal said.

Future studies should explore other ways to educate and communicate with heart failure patients, including using the Internet. Researchers also should look at how to optimally increase adherence in heart failure patients with depressive symptoms or cognitive decline, she said.