Caring for patients with chronic heart failure

Sammanfattning: The overall aim of this thesis was to describe and evaluate patient education and nurse-led follow up for patients with heart failure. Descriptive designs were used to map out the nurse-led heart failure care in Sweden (I) and to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure.(II) An interactive computer-based multimedia program for the education of patients with heart failure was developed and tested (III) and the effects on knowledge, compliance and quality of life evaluated in a randomised study. (IV) The effects of nurse-led heart failure clinics on mortality, morbidity, health-related quality of life and self-care behaviour in patients hospitalised due to heart failure were also evaluated in a randomised study.(V) Heart failure nurses and nurse-led heart failure clinics were introduced in Sweden in 1990. After 8 years the model has  spread to two thirds of the Swedish hospitals. In total 148 heart failure nurses were involved in education and follow up of patients with heart failure. (I) The compliance with therapeutic regimens was influenced by inward factors; the personality of the patient, the disease and the treatment and outward factors; social activities and relationships to family, friends and health care professionals.(II) The patients with heart failure were satisfied with computer-based education and positive in their attitude towards the computer. There was no need for computer experience in order to run an interactive computer-based program and high age was not a problem for using the program independently.(III) Computer-based education gave increased and more lasting knowledge about heart failure compared to traditional teaching, but compliance was not improved by single-session education. Quality of life was improved after 6 months by both traditional and computer-based education, but only for the men. (IV) Follow up after hospitalisation at a nurse-led heart failure clinic improved survival and selfcare behaviour in patients with heart failure as well as reduced the number of events, readmissions and days in hospital. (V)