Effect of a nurse-led multidisciplinary programme on quality of life, anxiety and depression in heart failure

Abstract

Previous studies show that improving emotional wellbeing in heart failure remains challenging. Difficulties often persist even when physical symptoms are addressed. The aim of the current multicenter RCT was to evaluate the effectiveness of an individualized multidisciplinary management program in patients with heart failure to improve patients’ health related quality of life (HR-QoL)(Minnesota Living with Heart Failure questionnaire’ -MLHFQ) and possible anxiety and depression (HADS questionnaire) compared to the ‘usual’ care. A sequential exploratory approach was used in order to develop the content of the intervention for the Randomized Control Trial (RCT) named ‘SupportHeart’. The RCT consisted by two groups; the intervention group (IG) and the control group (CG). The intervention was a pragmatic, nurse-led supportive care programme for patients with heart failure, initiated at discharge with bedside education and written materials. Follow-up included a telephone contact at 48 hours post-discharge, then monthly face-to-face meetings and monthly phone calls, providing ongoing support, guidance and referral to available services and evidence-based resources, delivered to the participants in IG. The CG received standard care. The study investigated the patients with HF for a period of one year at 5 time points (in baseline, 1 month, 3 months, 6 months, 1 year). Comparisons between IG and CG at each time point were assessed using a Welsch t-test. Comparisons of lost to follow- up between the two groups was assessed using the Fisher’s exact test. For the effect of the intervention on the Scales’ scores (MLHFQ, HADS) Linear Mixed Models Effects (LMME) were performed with the level of the scale as the dependent variable, and independent variables the group (CG, IG), the time-point (baseline, 1 month, 3 months, 6 months, 1 year) and the interaction between group and time-point (Group X Time). Two hundred two patients participated in the study with an overall mean age of 71.8 (SD = 10.9) years old. The 65 of them (32%) were women. LMME results have shown that there is a statistically significant effect of the Intervention on the Physical dimension at 1 month after the intervention (p = 0.022) and on the Emotional dimension, at 1 month (p = 0.004) and 3 months (p = 0.037) after the intervention (Graph 1). At 3 months, 6 months and 1 year, IG had lower Emotional Distress compared to CG (p < 0.001)(Graph2). The SupportHeart programme demonstrates that ongoing support delivered by a nurse-led multidisciplinary team can improve HRQoL, with particularly strong benefits for psychological wellbeing. Its pragmatic design enables tailored, individualised care that can be implemented across different healthcare systems, even in challenging settings, by flexibly drawing on all available resources.Graph 1. Health Related Quality of LifeGraph2. Anxiety and Depression