Ivonne Lesman

Design and methodology of the COACH study: a multicenter randomised Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure.

While there are data to support the use of comprehensive non‐pharmacological intervention programs in patients with heart failure (HF), other studies have not confirmed these positive findings. Substantial differences in the type and intensity of disease management programs make it impossible to draw definitive conclusions about the effectiveness, optimal timing and frequency of interventions.

Quality of life in partners of people with congestive heart failure : gender and involvement in care.

AIM This paper is a report of a study conducted to investigate quality of life in partners of people with congestive heart failure in comparison to individuals living with a healthy partner. BACKGROUND Congestive heart failure is a chronic debilitating disease with severe symptoms and complex treatment. The support of partners is essential in the management of congestive heart failure. Living with a chronic illness generally affects the quality of life of patients and their partners. METHOD Data were collected using a cross-sectional, comparative design between October 2002 and February 2005 with 303 partners of people with congestive heart failure. Reference data were collected in 304 age- and gender-matched individuals living with a healthy partner, drawn from the general population. All respondents completed questionnaires at home on quality of life and general well-being. Analysis of variance was used to analyse the data. FINDINGS Overall, differences in quality of life between partners of people with heart failure and matched controls were small. However, substantial variation in the quality of life of partners was found by exploring the role of gender and involvement in care. Quality of life scores varied strongly for male and female partners who had to perform caregiving tasks. The performance of these caregiving tasks was negatively associated with the quality of life of female partners but not with that of male partners. CONCLUSION Female partners especially should not be overlooked when they become involved in personal care tasks. Nurses should not be reluctant to involve male partners in caring for women with heart failure.

The value of telemonitoring and ICT-guided disease management in heart failure : Results from the IN TOUCH study

AIM It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. METHODS A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS+telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). RESULTS In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS+telemonitoring (mean difference 0.1, 95% CI: -0.67 +0.82, p=0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS+telemonitoring (p=0.27); HF-readmission 28% vs. 27% p=0.87; all-cause readmission was 49% vs. 51% (p=0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were €1360 in favor of ICT-guided-DMS. ICT-guided-DMS+telemonitoring had significantly fewer HF-outpatient-clinic visits (p<0.01). CONCLUSION ICT-guided-DMS+telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs.

Psychology and cardiology: do not forget the heart failure patient.

With great interest we read the article ‘Psychological treatment in cardiac patients: a meta analysis’ of Linden et al. 1 The authors report a mortality benefit of 27% of psychological treatment in cardiac patients for at least the first 2 years and 43% reduction of event recurrence at follow-up longer than 2 years. Interestingly, no effects were found for women either on mortality or on morbidity. Despite acknowledging the dangers of sub-analyses, …

1242: Coordinating Study Evaluating Outcomes of Advising and Counselling in Heart Failure (COACH): Methodology and Design

Purpose: In seeking evidence to support the local practice of keeping patients on bed rest fo r 6 h following cardiac catheterisation and percutaneous coronary intervention (PCI), very little literature was found. In order to establish the safety of reducing bed rest, practice was benchmarked and audited. Methods: A benchmarking exercise was undertaken against nine other cardiac centres, which revealed an average bed rest time of 5–6 h. A baseline audit of current practice was conducted to establish complication rates related to femoral wound site and length of bed rest. Using a convenience sample of consecutive patients, a total number of 200 data sets (195 complete ) were obtained using a specifically designed audit tool. The audit was repeated following a reduction in bed rest t o 3 h and a further 200 data sets were collected(176 complete ) using the same tool. Results: 358 (96.2%) of cases used six French sheath and only 120(32.3%) used an arterial closure device, all others used manual compression (average time s10 min) to achieve haemostasis. Similar ratios of male yfemale and diagnosticyinterventional cases were documented pre and post change. Numbers of haematomas reduced from 29 prechange(14.8%) to 19 post-change(10.8%). Number of oozing or bleeding incidents increased from 5 (2.6%) to 11 (6.3%). Conclusion: Femoral wound site complication rates were not significantly affected by reducing bed rest time for diagnostic or interventional procedures. Practice can now be based on best available evidence thus ensuring high standards of care.