Elsevier

Australian Critical Care

Volume 22, Issue 3, August 2009, Pages 133-140
Australian Critical Care

Tailoring consumer resources to enhance self-care in chronic heart failure

https://doi.org/10.1016/j.aucc.2009.05.003Get rights and content

Summary

Background

Chronic heart failure (CHF) is associated with high hospitalisation and mortality rates and debilitating symptoms. In an effort to reduce hospitalisations and improve symptoms individuals must be supported in managing their condition. Patients who can effectively self-manage their symptoms through lifestyle modification and adherence to complex medication regimens will experience less hospitalisations and other adverse events.

Aim

The purpose of this paper is to explain how providing evidence-based information, using patient education resources, can support self-care.

Discussion

Self-care relates to the activities that individuals engage in relation to health seeking behaviours. Supporting self-care practices through tailored and relevant information can provide patients with resources and advice on strategies to manage their condition. Evidence-based approaches to improve adherence to self-care practices in patients with heart failure are not often reported. Low health literacy can result in poor understanding of the information about CHF and is related to adverse health outcomes. Also a lack of knowledge can lead to non-adherence with self-care practices such as following fluid restriction, low sodium diet and daily weighing routines. However these issues need to be addressed to improve self-management skills.

Outcome

Recently the Heart Foundation CHF consumer resource was updated based on evidence-based national clinical guidelines. The aim of this resource is to help consumers improve understanding of the disease, reduce uncertainty and anxiety about what to do when symptoms appear, encourage discussions with local doctors, and build confidence in self-care management.

Conclusion

Evidence-based CHF patient education resources promote self-care practices and early detection of symptom change that may reduce hospitalisations and improve the quality of life for people with CHF.

Section snippets

Background

Self-care in chronic heart failure (CHF) and health outcomes are closely linked. Mortality and hospitalisation rates remain high, particularly in the elderly. In Australia, approximately 40,000 patients were hospitalised with newly diagnosed CHF in 2003.1 Patients with CHF experience debilitating symptoms such as shortness of breath, increasing exercise intolerance and lethargy which impacts on their everyday day life. In an effort to reduce these symptoms and hospitalisations patients must

Self-care of heart failure

Self-care involves cognitive decision making, requiring the recognition of signs and symptoms that indicate a change in condition, which is based on knowledge and prior experiences of deterioration.3, 7 It also refers to the ability to engage in constructive behaviours to monitor and maintain health.3

Self-management of CHF depends on patient adoption of healthy behaviours and management strategies. Patients living with a chronic illness often find self-care decision making overwhelming.11

Adherence with self-care

Adherence with self-care is vital in chronic disease management and has been shown to reduce morbidity and mortality.14 The capacity to adhere with recommended treatment strategies is often suboptimal in individuals with CHF, especially in those who are recently diagnosed. A study by Michalsen et al.15 surveyed 179 patients admitted to hospital with an exacerbation of HF. All of the patients had a previous diagnosis of HF. No education about heart failure was given to patients prior to their

Knowledge of self-care

Knowledge and understanding are essential elements for patient empowerment and successful self-management. Information and resources used to provide this knowledge should be evidence-based to maximise opportunities for improving patient satisfaction and health outcomes.20

A lack of knowledge can lead to non-adherence with self-care practices such as following fluid restriction, low sodium diet and daily weighing routines.3 Ni et al.21 investigated 41 hospitalised heart failure patients and found

Health professional support of self-care practices

Health care providers can influence adherence to treatment.23 Simpson24 describes a constructive patient–provider relationship as one of trust that motivates patients to adhere to lifestyle changes and complex medication regimes. In spite of the importance of providing timely and relevant information, there is evidence to suggest that health care providers do not always use consumer resources within education opportunities. For example the results of a recent survey of 496 general practitioners

Health literacy in supporting self-care

Health literacy refers to an individual's ability to use and interpret information relating to health issues. Low health literacy can result in poor understanding of the information about CHF and is related to adverse health outcomes. Approximately 83% of Australians aged over 65 years have a health literacy level that is below the minimum required to meet the complex demands of everyday life.26 The elderly population also has the poorest health literacy skills27 and are the biggest users of

Living well with chronic heart failure

‘Living well with chronic heart failure’ consumer resource has been developed as a companion to the CHF guideline and as such communicates management strategies that are well known to optimise health outcomes.10 The consumer oriented approach to resource development ensures information is tailored to patient needs. Table 1 gives examples of how the clinical content and format and layout has been adapted for consumers.

One important component of the consumer resource is the action plan (Fig. 1).

Conclusion

Patients in contemporary health care systems, together with their health care provider, need to engage in partnerships to promote self-care strategies. In order to be effective partners, patients need and want accurate, practical information and advice; ‘Living well with chronic heart failure’ underpinned by a robust evidence-base on self-care, has been developed to address this need. In particular, this resource targets newly diagnosed or hospitalised people with heart failure. As a practical

Acknowledgements

“Living well with chronic heart failure” (2008) Members of the Heart Failure Consumer Resource Working Group: Roshmeen Azam, National Prescribing Service; Meredith Cameron, National Institute of Clinical Studies; Eleanor Clune, National Heart Foundation of Australia; James McVeigh, Prince of Wales Hospital, Sydney; Vilma Paguio, National Heart Foundation of Australia; Graeme Percival, Consumer; Sue Phillips, National Institute of Clinical Studies; Sepehr Shakib, Royal Adelaide Hospital; Agnes

References (37)

  • T. Jaarsma et al.

    Effects of education and support on self-care and resource utilization in patients with heart failure

    Eur Heart J

    (1999)
  • B. Riegel et al.

    A situation-specific theory of heart failure self-care

    J Cardiovasc Nurs

    (2008)
  • National Heart Foundation of Australia

    Living well with chronic heart failure

    (2008)
  • H. Krum et al.

    CHF Guidelines Core Writers. Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006

    Med J Aust

    (2006)
  • S. Thorne et al.

    The structure of everyday self-care decision making in chronic illness

    Qual Health Res

    (2003)
  • D. Moser et al.

    Conceptualizing self-care in heart failure: a life course model of patient characteristics

    J Cardiovasc Nurs

    (2008)
  • N.M. Albert

    Promoting self-care in heart failure: state of clinical practice based on the perspectives of healthcare systems and providers

    J Cardiovasc Nurs

    (2008)
  • A. Michalsen et al.

    Preventable causative factors leading to hospital admission with decompensated heart failure

    Heart

    (1998)
  • Cited by (32)

    • Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends

      2015, Clinical Therapeutics
      Citation Excerpt :

      CHF management programs focus on providing information and support to patients and their caregivers in self-management. Appropriate screening (eg, health literacy, cognition, depression) and negotiation of treatment goals is important in effective care planning, and the importance of tailoring and targeting self-care resources is increasingly being recognized.45 Counseling, home visits, 24-hour call centers, and reminder systems have been applied in various configurations to augment CHF management.

    • Psychoeducational support to post cardiac surgery heart failure patients and their partners-A randomised pilot study

      2015, Intensive and Critical Care Nursing
      Citation Excerpt :

      Our findings show increased health and better control, especially for the patients, when patient–partner had postoperative contacts and follow up with healthcare professionals. Fewer opportunities exist to provide necessary information and respond to patient concerns in hospital, and much of the process of wound healing and recovery that previously took place in hospital occurs after discharge (Driscoll et al., 2009). All surgical procedures affect the physical and mental conditions of patient–partner to some degree.

    • Implementing guideline based heart failure care in the northern territory: Challenges and solutions

      2014, Heart Lung and Circulation
      Citation Excerpt :

      Realistic goals and timeframes, broad discussions, support that is ongoing, comprehensive, coordinated, accessible, user friendly; communication that is efficient and in real time; service delivery with cultural competence, sensitivity and evidence based, are at the heart of the discussions for urban and specialist outreach services. In addition, planning for projected population increases and meeting unmet clinical and investigational needs with staffing and infrastructure suggest a one-dimensional surge of resources may not address issues [1–25]. These issues are agenda items within the NT Cardiovascular reference group, which is open to feedback on the issues discussed in this paper.

    • AUStralian indigenous chronic disease optimisation study (AUSI-CDS) prospective observational cohort study to determine if an established chronic disease health care model can be used to deliver better heart failure care among remote indigenous Australians: Proof of concept-study rationale and protocol

      2013, Heart Lung and Circulation
      Citation Excerpt :

      It is generally accepted that inadequate provision of usual therapies contributes to poorer outcomes. This picture of worse disease and poorer care delivery is particularly evident in the Northern Territory of Australia with a vast area serviced by two major public hospitals [1–13]. In excess of 70,000 Indigenous Australians live in the NT, 63% remotely, with 70 spoken languages.

    • Intelligent Medical Interactive Educational System for Cardiovascular Disease

      2022, Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)
    View all citing articles on Scopus
    1

    On behalf of the National Heart Foundation Heart Failure Consumer Resource Working Group.

    2

    Tel.: +61 03 9903 0229; fax: +61 03 9903 0556.

    3

    Tel.: +61 2 8399 7831; fax: +61 2 8399 7834.

    4

    Tel.: +61 8 8302 1532/0419 856172 (Mobile); fax: +61 8 8302 2578.

    5

    Tel.: +61 03 9321 1524; fax: +61 03 9321 1574.

    View full text