Dyads 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 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.

A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes

“…However, there was great heterogeneity and incompleteness in reporting both the number of sessions and time spent per session precluding an accurate description of dose and strength of dose for some interventions. As an example of this heterogeneity, Ågren et al (Agren et al, 2012) reported an intervention comprised of three components (face-to-face counseling, computer-based program and written materials). The intervention involved three sessions of 60 minutes each suggesting 180 minutes of direct contact with an interventionist during the intervention.…”

“…Countries where interventions were tested included the United States, (Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Piamjariyakul et al, 2015;Piette et al, 2008;Piette et al, 2015) Sweden, (Ågren et al, 2015;Agren et al, 2012) New Zealand, (Kenealy et al, 2015) Iran, (Hasanpour-Dehkordi et al, 2016) and Thailand. (Srisuk et al, 2015) Settings where the intervention was initiated or where the majority of the interventions were delivered included hospitals, (Agren et al, 2012;Bull et al, 2000;Hasanpour-Dehkordi et al, 2016;Kenealy et al, 2015;Piette et al, 2008;Schwarz et al, 2008) clinics, (Ågren et al, 2015;Agren et al, 2012;Dunbar et al, 2013;Piamjariyakul et al, 2015;Srisuk et al, 2015) home, (Agren et al, 2012) a U.S. Veterans Administration (clinic or hospital), (Piette et al, 2008;Piette et al, 2015) and in a clinical research center. (Dunbar et al, 2005) Two studies (Agren et al, 2012;Piette et al, 2008) included multiple sites to support the transition from hospital to home or increase recruitment.…”

“…The 12 interventions aligned into three delivery contexts -those which could be categorized as face-to-face; (Ågren et al, 2015;Agren et al, 2012;Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Hasanpour-Dehkordi et al, 2016;Srisuk et al, 2015) telephone; (Piamjariyakul et al, 2015) or telehealth interventions (see Table 2). (Kenealy et al, 2015;Piette et al, 2008;Piette et al, 2015;Schwarz et al, 2008) Most face-to-face interventions also used some form of technology including DVD/video, (Bull et al, 2000;Dunbar et al, 2005;Srisuk et al, 2015) website, (Agren et al, 2012) or phone calls (Ågren et al, 2015;Dunbar et al, 2005;Dunbar et al, 2013;Srisuk et al, 2015) blurring the line between "high touch" and "high tech" modalities. It appears that all the studies were investigator-initiated and led.…”

“…Patient perceived control at 3 months (Ågren et al, 2015;Agren et al, 2012) and 12 months (Ågren et al, 2015) Carer perceived control at 3 months (Srisuk et al, 2015) Patient quality of life at 3 (Srisuk et al, 2015) and 6 months (Hasanpour-Dehkordi et al, 2016;Srisuk et al, 2015) Patient preparedness to care at 2 weeks (Bull et al, 2000) Carer reaction to caregiving (Bull et al, 2000) Patient knowledge (Dunbar et al, 2013) Patient/Carer knowledge (Dunbar et al, 2005;Srisuk et al, 2015) Patient perceived control at 12 months (Agren et al, 2012) Carer perceived control at 6 months (Srisuk et al, 2015) Patient/Carer perceived control at 24 months (Liljeroos et al, 2015) Patient quality of life at 3 months (Schwarz et al, 2008) Patient/Carer quality of life at 3 months (Agren et al, 2012) Patient quality of life at 6 months (Kenealy et al, 2015) Carer preparedness to care at 6 months (Piamjariyakul et al, 2015) Patient/Carer satisfaction with care (Bull et al, 2000) Patient ( …”

“…Patient/Carer depression at 6 months (Kenealy et al, 2015;Piamjariyakul et al, 2015;Piette et al, 2015) Patient social support at 6 months (Piamjariyakul et al, 2015) Carer confidence (Piamjariyakul et al, 2015) Patient anxiety (Kenealy et al, 2015) Carer strain (Piette et al, 2015) Patient depression at 3 months, (Dunbar et al, 2005;Schwarz et al, 2008) Patient/Carer depression at 12 months (Ågren et al, 2015;Agren et al, 2012) and 24 months (Liljeroos et al, 2015) Carer social support at 3 months (Schwarz et al, 2008) Carer burden (Agren et al, 2012;Agren et al, 2015) Depression affective, and health services utilization). In the main outcome papers of the complete studies only one paper reported null findings on all outcomes.…”