Dyads Affected by Chronic Heart Failure: A Randomized Study Evaluating Effects of Education and Psychosocial Support to Patients With Heart Failure and Their Partners

doi:10.1016/j.cardfail.2012.01.014

Journal of Cardiac Failure

Volume 18, Issue 5, May 2012, Pages 359-366

https://doi.org/10.1016/j.cardfail.2012.01.014 Get rights and content

Abstract

Background

Chronic heart failure (CHF) causes great suffering for both patients and their partners. The aim of this study was to evaluate the effects of an integrated dyad care program with education and psychosocial support to patients with CHF and their partners during a postdischarge period after acute deterioration of CHF.

Methods

One hundred fifty-five patient-caregiver dyads were randomized to usual care (n = 71) or a psychoeducation intervention (n = 84) delivered in 3 modules through nurse-led face-to-face counseling, computer-based education, and other written teaching materials to assist dyads to develop problem-solving skills. Follow-up assessments were completed after 3 and 12 months to assess perceived control, perceived health, depressive symptoms, self-care, and caregiver burden.

Results

Baseline sociodemographic and clinical characteristics of dyads in the experimental and control groups were similar at baseline. Significant differences were observed in patients’ perceived control over the cardiac condition after 3 (P < .05) but not after 12 months, and no effect was seen for the caregivers.No group differences were observed over time in dyads’ health-related quality of life and depressive symptoms, patients’ self-care behaviors, and partners’ experiences of caregiver burden.

Conclusions

Integrated dyad care focusing on skill-building and problem-solving education and psychosocial support was effective in initially enhancing patients’ levels of perceived control. More frequent professional contact and ongoing skills training may be necessary to have a higher impact on dyad outcomes and warrants further research.

Section snippets

Design and Setting

A randomized controlled design with follow-up assessment after 3 and 12 months was used to evaluate the effects of a 12-week intervention with education and psychosocial support delivered in 3 sessions to patient-partner dyads. The short-term follow-up after 3 months reflects the effects of the intervention soon after its termination, and the assessment at 12 months was used to measure the long-term effects of the intervention.

The setting was 1 university hospital and 1 county hospital in

Results

A total of 155 dyads were included in the study and completed baseline assessment (Fig. 1). Clinical and demographic characteristics of the dyads are described in Table 2, Table 3. The majority of the patients were men and the majority of the partners women. NYHA functional class III was the dominant function class of the patients.

The intervention lasted up to 12 weeks, and the follow-up evaluation presented in this study was carried out after 3 and 12 months. The patients had low control at

Discussion

To our knowledge, this is the first major randomized study to examine the effects of a theory-based intervention with education and psychosocial support for patients with CHF and their partners. Our main finding was that perceived control significantly improved in the patients at short-term follow up. This is an important outcome, because earlier studies have shown that a higher level of perceived control is important to reduce psychologic stress.³¹ Poor functional status of the caregiver,

Conclusion

The dyad care program focusing on the development of problem-solving skills to assist the dyads in managing CHF significantly improved the level of perceived control over the heart disease in the patient group during short-term follow up. In other aspects, such as physical and mental well-being, self-care, and caregiver burden experienced, the effects were limited in both patients and partners.

Acknowledgments

We thank Linköping University, the Swedish Institute for Health Science, the Swedish Research Council and the Health Sciences Centre for financial support. We also thank the partners and chronic HF patients who participated in the study, the secretaries at the Department of Cardiology and Emergency Department, especially Lotta Björk and Berit Anderson, and Annette Waldemar and Lillevi Nestor at the county hospital in Norrköping for support with data collection and intervention. Thanks also to

Disclosures

None.

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: Funding: Grants from Linköping University, Swedish Research Council, Swedish Institute for Health Sciences, Heart and Lung Foundation, Heart and Lung Disease National Association, and Lions Research Foundation.

: See page 365 for disclosure information.

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Clinical TrialDyads Affected by Chronic Heart Failure: A Randomized Study Evaluating Effects of Education and Psychosocial Support to Patients With Heart Failure and Their Partners

Abstract

Background

Methods

Results

Conclusions

Section snippets

Design and Setting

Results

Discussion

Conclusion

Acknowledgments

Disclosures

Am J Cardiol

Heart Lung

Patient Educ Couns

Heart Lung

Arch Phys Med Rehabil

Heart Lung

J Psychosom Res

Heart Lung

International Journal of Cardiology

Eur J Heart Fail

AHA heart disease and stroke statistics 2009

Circulation

The objective burden in partners of heart failure patients; development and initial validation of the Dutch Objective Burden Inventory

Eur J Cardiovasc Nurs

Family carers’ experiences using support services in Europe: empirical evidence from the EUROFAMCARE study

Gerontologist

Social support and self-care in heart failure

J Cardiovasc Nurs

Do partners of patients with heart failure experience caregiver burden?

Eur J Cardiovasc Nurs

Risk factors for potentially harmful informal caregiver behavior

J Am Geriatr Soc

Family caregiving and congestive heart failure. Review and analysis

Eur J Heart Fail

Living with advanced heart failure: a prospective, community based study of patients and their carers

Eur J Heart Fail

Adherence to long-term therapies. Evidence for action

Eur J Cardiovasc Nurs

Can we talk? Developing a social support nursing intervention for couples

Clin Nurse Spec

Clinical Trial
Dyads Affected by Chronic Heart Failure: A Randomized Study Evaluating Effects of Education and Psychosocial Support to Patients With Heart Failure and Their Partners