53
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Educational settings in the management of patients with heart failure Translated title: Escenarios de educación para el manejo de pacientes con insuficiencia cardiaca Translated title: Cenários de educação para o manejo de pacientes com insuficiência cardíaca

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Congestive heart failure (CHF) presents, besides the magnitude of epidemiological data, relevant characteristics, including frequent hospitalizations caused by severe signs and symptoms, which should be studied to reduce the negative impact of the disease on the public health system. With the advent of several clinical trials in the area of CHF, the treatment has become more complex, with the need of a more organized structure to assist these patients. Education is considered essential to reduce morbidity and mortality. The setting, to begin or to continue the educational process, can be a hospital (hospitalization), outpatient clinic, home, a day-hospital or yet, a combination of these. The main researches in this area recognize and motivate an investigation of other paths to get better results in the pharmacological and non-pharmacological treatments. In this study we review recent data, approaching several educational settings in the management of patients with CHF.

          Translated abstract

          La insuficiencia cardiaca congestiva (ICC) además de la magnitud epidemiológica, presenta características relevantes, entre las que se incluyen hospitalizaciones frecuentes debidas a la exacerbación de signos y síntomas, los cuales deben ser ampliamente abordados para reducir el impacto negativo de la enfermedad en el sistema público de salud. Con la aparición de nuevos ensayos clínicos en el área de ICC, el tratamiento pasó a ser más complejo, surgiendo la necesidad de una estructura más organizada para la atención de los pacientes afectados. En este contexto, la educación es considerada esencial para reducir la morbimortalidad, siendo el escenario ideal para dar continuidad en el proceso educativo, el ambiente hospitalario (internación), el ambiente de ambulatorio, el domiciliar, en la rutina diaria del hospital, o en la combinación de éstos. Investigadores del área reconocen y estimulan a la investigación, de tal modo que sea posible mejorar los resultados en el tratamiento farmacológico y no-farmacológico. En este artículo revisaremos información contemporánea, abordando los diversos escenarios de educación para el manejo del pacientes con ICC.

          Translated abstract

          A insuficiência cardíaca congestiva (ICC) apresenta, além da magnitude dos dados epidemiológicos, características relevantes, incluindo hospitalizações freqüentes devidas à exacerbação dos sinais e sintomas, que devem ser mais amplamente abordados para reduzir o impacto negativo da doença sobre o sistema público de saúde. Com o advento dos vários ensaios clínicos na área de ICC, o tratamento da doença passou a ser mais complexo, necessitando de uma estrutura organizada para o atendimento de pacientes por ela acometidos. A educação, nesse contexto, é considerada essencial para reduzir a morbimortalidade. O cenário, para o início ou a continuidade do processo educativo, pode ser hospitalar (internação), ambulatorial, domiciliar, hospital-dia ou, ainda, ser uma combinação desses ambientes. Os principais pesquisadores nessa área reconhecem e estimulam a investigação de outros caminhos, que melhorem os resultados no tratamento farmacológico e não-farmacológico. Neste artigo, revisaremos dados contemporâneos, abordando os diversos cenários da educação para o manejo de pacientes com ICC.

          Related collections

          Most cited references40

          • Record: found
          • Abstract: found
          • Article: not found

          Randomized trial of an education and support intervention to prevent readmission of patients with heart failure.

          We determined the effect of a targeted education and support intervention on the rate of readmission or death and hospital costs in patients with heart failure (HF). Disease management programs for patients with HF including medical components may reduce readmissions by 40% or more, but the value of an intervention focused on education and support is not known. We conducted a prospective, randomized trial of a formal education and support intervention on one-year readmission or mortality and costs of care for patients hospitalized with HF. Among the 88 patients (44 intervention and 44 control) in the study, 25 patients (56.8%) in the intervention group and 36 patients (81.8%) in the control group had at least one readmission or died during one-year follow-up (relative risk = 0.69, 95% confidence interval [CI]: 0.52, 0.92; p = 0.01). The intervention was associated with a 39% decrease in the total number of readmissions (intervention group: 49 readmissions; control group: 80 readmissions, p = 0.06). After adjusting for clinical and demographic characteristics, the intervention group had a significantly lower risk of readmission compared with the control group (hazard ratio = 0.56, 95% CI: 0.32, 0.96; p = 0.03) and hospital readmission costs of $7,515 less per patient. A formal education and support intervention substantially reduced adverse clinical outcomes and costs for patients with HF.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Systematic review of multidisciplinary interventions in heart failure.

            To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure. Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required. Randomised controlled trials conducted in both hospital and community settings. Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure. Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded. All cause hospital admission, all cause mortality, and heart failure hospital admission. 74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p = 0.002), although significant heterogeneity was found (p = 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p = 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p < 0.001). These results varied little with sensitivity analyses. Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.

              Congestive heart failure is the most common indication for admission to the hospital among older adults. Behavioral factors, such as poor compliance with treatment, frequently contribute to exacerbations of heart failure, a fact suggesting that many admissions could be prevented. We conducted a prospective, randomized trial of the effect of a nurse-directed, multidisciplinary intervention on rates of readmission within 90 days of hospital discharge, quality of life, and costs of care for high-risk patients 70 years of age or older who were hospitalized with congestive heart failure. The intervention consisted of comprehensive education of the patient and family, a prescribed diet, social-service consultation and planning for an early discharge, a review of medications, and intensive follow-up. Survival for 90 days without readmission, the primary outcome measure, was achieved in 91 of the 142 patients in the treatment group, as compared with 75 of the 140 patients in the control group, who received conventional care (P = 0.09). There were 94 readmissions in the control group and 53 in the treatment group (risk ratio, 0.56; P = 0.02). The number of readmissions for heart failure was reduced by 56.2 percent in the treatment group (54 vs. 24, P = 0.04), whereas the number of readmissions for other causes was reduced by 28.5 percent (40 vs. 29, P not significant). In the control group, 23 patients (16.4 percent) had more than one readmission, as compared with 9 patients (6.3 percent) in the treatment group (risk ratio, 0.39; P = 0.01). In a subgroup of 126 patients, quality-of-life scores at 90 days improved more from base line for patients in the treatment group (P = 0.001). Because of the reduction in hospital admissions, the overall cost of care was $460 less per patient in the treatment group. A nurse-directed, multidisciplinary intervention can improve quality of life and reduce hospital use and medical costs for elderly patients with congestive heart failure.
                Bookmark

                Author and article information

                Journal
                rlae
                Revista Latino-Americana de Enfermagem
                Rev. Latino-Am. Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo (, SP, Brazil )
                0104-1169
                1518-8345
                April 2007
                : 15
                : 2
                : 344-349
                Affiliations
                [02] orgnameFederal University of Rio Grande do Sul orgdiv1Medical School clausell@ 123456portoweb.com.br
                [03] orgnameHospital de Clínicas of Porto Alegre<
                [01] orgnameFederal University of Rio Grande do Sul orgdiv1College of Nursing
                Article
                S0104-11692007000200023 S0104-1169(07)01500223
                f5fc29ee-b6c1-41f2-9238-41f9e1123c5f

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 20 March 2005
                : 13 September 2006
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 6
                Product

                SciELO Brazil

                Categories
                Review Articles

                autocuidado,nursing,heart failure, congestive,enfermería,educação,education, self care,insuficiência cardíaca congestiva,insuficiencia cardiaca congestiva,educación,enfermagem

                Comments

                Comment on this article

                Similar content271

                Cited by6

                Most referenced authors349