University of Connecticut School of Nursing, Storrs, CT, USA.
J Cardiovasc Nurs. 2010 Sep-Oct;25(5):E27-40. doi: 10.1097/JCN.0b013e3181da2f79.
Heart failure (HF) has clinically significant psychological and physical consequences for older persons, and hospitalization for HF is frequent and costly to the Medicare program. As HF is the most common primary Medicare home care diagnosis, there is a critical need to develop home care services that improve heath-related outcomes for this population. The primary aim of this pilot study was to develop, implement, and test the initial feasibility and potential efficacy of the Home-Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. Observed outcomes were quality of life (QOL), depressive symptoms, and 90-day hospitalization.
Twenty-four patients with a primary diagnosis of HF were assigned to the intervention (n = 12) or control group (n = 12) according to geographical location in a large multibranch Medicare-certified home health agency. Intervention group patients received 8 structured nurse education visits using evidence-based protocols designed in previous trials to teach HF self-management and to prevent/reduce depression, as well as a telemonitoring system. Control group patients received usual care and telemonitoring. Quality of life was assessed using the Minnesota Living With Heart Failure questionnaire. Depressive symptoms were assed using the Patient Health Questionnaire 9 at baseline and 90-day study end point.
Study protocols and instrumentation were found to be feasible and effective. Examination of enrollment data led to a reevaluation of eligibility criteria. Patients participating in the HEART intervention demonstrated significantly improved QOL (F = 8.99, P = .007) and significantly reduced depressive symptoms (F = 35.10, P = .001) in comparison to control group patients at the study end point. There was a trend toward lower hospital readmission rates in the intervention group (16% vs 25%), but this was not statistically significant.
This pilot study suggests that a full-scale trial of the HEART intervention is feasible.
心力衰竭（HF）对老年人有明显的心理和生理影响，HF 住院治疗对医疗保险计划来说频繁且昂贵。由于 HF 是医疗保险计划中最常见的初级家庭护理诊断，因此迫切需要开发改善该人群健康相关结果的家庭护理服务。本试点研究的主要目的是开发、实施和测试 Home-Care Education、Assessment、Remote-Monitoring、and Therapeutic Activities（HEART）试验的初步可行性和潜在疗效，这是一项由护士主导的多组分家庭护理干预措施。观察结果为生活质量（QOL）、抑郁症状和 90 天住院率。
根据大型多分支机构医疗保险认证家庭健康机构的地理位置，24 名 HF 主要诊断患者被分配到干预组（n=12）或对照组（n=12）。干预组患者接受 8 次基于证据的协议的结构化护士教育访问，这些协议旨在教授 HF 自我管理和预防/减少抑郁，以及远程监测系统。对照组患者接受常规护理和远程监测。生活质量使用明尼苏达州心力衰竭生活质量问卷进行评估。抑郁症状使用患者健康问卷 9 在基线和 90 天研究终点进行评估。
研究方案和仪器被证明是可行和有效的。对入组数据的检查导致对资格标准进行了重新评估。与对照组患者相比，参与 HEART 干预的患者在研究终点时 QOL 显著改善（F=8.99，P=.007），抑郁症状显著减轻（F=35.10，P=.001）。干预组的住院再入院率有下降趋势（16%对 25%），但无统计学意义。
这项试点研究表明，HEART 干预的全面试验是可行的。
