Randomized controlled trial of comprehensive nursing intervention on readmission, mortality and quality of life among Egyptian heart failure patients: A 12 month follow up study

Abstract

Background: Despite major advances in the treatment options for heart failure (HF) patients, morbidity and mortality remain high. Frequent re-admissions are distressful for patients and are associated with large costs for society. Improved self-care behaviour is a goal in educational programmes for patients with HF. The primary outcome measure of this study was to determine the effect of pre-discharge educational intervention and post- discharge intervention carried out by nursing staff on re-admission, mortality and quality of life.

Methods: A randomized controlled clinical trial in patients who were admitted to hospital with a diagnosis of HF. A total of 60 patients were randomly assigned (using a random number table) to either intervention group or a control group of 30 patients each. The intervention group participated in educational programme using face to face education before discharge, outpatient HF nursing intervention and monthly telephone call for over nine months to remind them about the main instruction in addition to the written instruction of HF management with emphasis on self-care behaviour. In each visit, the nurse evaluated the HF status and treatment, gave education about HF and social support to the intervention group.  The control group received usual care and given a HF management written instruction.

Results: Patients in the intervention group was found to have a 66.67% decrease in the total number of readmission as compared to the control group (5 vs 25; p = .001), fewer death (2 vs 6; p = .04), and improved quality of life (t= 27.06; P = .001). Furthermore, results showed significant improvement in HF knowledge level (t = 7.85; P = .001) and compliance of health behaviours (t = 15.72; P = .001), in the intervention group after 12 months of inclusion than those in the control group.

Conclusions: A comprehensive HF nursing intervention substantially reduced re-admission, death, increased compliance with self-management and improved HF QoL. The results of this study building on the work of others, suggest that all patients with HF should be offered pre-discharge education, post-discharge out-patient nursing support and monthly telephone follow up.