Background

Although important, heart failure self-care remains a challenge for many patients. This study aimed to evaluate the effect of a nurse-led, home-based self-management psychosocial education intervention (HOM-HEMP). The primary outcome was patient's HF self-care in terms of maintenance, management and confidence. The secondary outcomes were cardiac self-efficacy, psychological wellbeing in terms of perceived social support, health related quality of life and levels of anxiety and depression. The clinical outcomes included New York Heart Association (NYHA) functional class and numbers of unplanned health service visits due to cardiac-related reasons.

Design

A three-arm stratified randomized controlled trial was conducted (Clinical trial registration number: NCT03108235).

Methods

A total of 213 participants admitted for heart failure were recruited from the inpatient wards of a tertiary public hospital in Singapore. They were randomly allocated to the control group, the experimental group A or the experimental group B. All participants received the usual care provided by the hospital. Participants in experimental groups A and B received the HOM-HEMP intervention, and those in experimental group B received an additional supplemental smartphone application. Data were collected at baseline, 6 weeks, 3 months and 6 months from baseline.

Results

Compared to the control groups, participants in either of the experimental group had significantly higher levels of heart failure self-care maintenance (F = 4.222, p = 0.001), self-care confidence (F = 5.796, p < 0.001) and self-care management (p < 0.05) at 6-week, 3-month and 6-month follow-ups. In addition, both experimental groups had significantly higher levels of cardiac self-efficacy, better health related quality of life and lower depression levels than the control group after the study intervention. A higher proportion of participants in both experimental groups had a better New York Heart Association functional class at 6-week and 3-month follow-ups. Participants in the experimental group B also had significantly fewer cardiac-related unplanned hospital admissions and emergency room visits than the control group at 6-month follow-up. Results on perceived social support were not significant. The study outcomes in experimental group A and B were not significantly different at any of the post intervention follow-up.

Conclusion

The findings suggested that HOM-HEMP is an effective intervention for patients with heart failure in Singapore.

中文翻译：

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护士主导的家庭心力衰竭自我管理计划 (HOM-HEMP) 对慢性心力衰竭患者的有效性：一项三臂分层随机对照试验

背景

尽管心力衰竭的自我护理很重要，但对许多患者来说仍然是一个挑战。本研究旨在评估护士主导的、以家庭为基础的自我管理心理社会教育干预措施 (HOM-HEMP) 的效果。主要结局是患者在维持、管理和信心方面的心力衰竭自我护理。次要结局是心脏自我效能、感知社会支持方面的心理健康、健康相关的生活质量以及焦虑和抑郁水平。临床结果包括纽约心脏协会 (NYHA) 功能分级以及由于心脏相关原因而计划外的医疗服务就诊次数。

设计

进行了三组分层随机对照试验（临床试验注册号：NCT03108235）。

方法

总共 213 名因心力衰竭入院的参与者是从新加坡一家三级公立医院的住院病房招募的。他们被随机分配到对照组、实验A组或实验B组。所有参与者均接受医院提供的常规护理。实验组 A 和 B 的参与者接受了 HOM-HEMP 干预，实验组 B 的参与者接受了额外的补充智能手机应用程序。数据在基线、基线后 6 周、3 个月和 6 个月收集。

结果

与对照组相比，任一实验组的参与者的心力衰竭自我护理维持水平（F = 4.222，p  = 0.001）、自我护理信心（F = 5.796，p  < 0.001）和自我护理水平均显着较高。  6 周、3 个月和 6 个月随访时的护理管理（p < 0.05）。此外，在研究干预后，两个实验组的心脏自我效能水平、健康相关生活质量和抑郁水平均显着低于对照组。在 6 周和 3 个月的随访中，两个实验组中较高比例的参与者具有更好的纽约心脏协会功能等级。在 6 个月的随访中，实验组 B 的参与者因心脏相关的计划外住院和急诊就诊的次数也明显少于对照组。感知社会支持的结果并不显着。实验组 A 和 B 的研究结果在任何干预后随访中均没有显着差异。

结论

研究结果表明，HOM-HEMP 是新加坡心力衰竭患者的有效干预措施。