Knowledge acquisition in patients with heart disease

Abstract

The general aim was to evaluate different aspects of the knowledge acquisition process in patients with heart disease. Three different education programs were evaluated.

In Paper I 208 patients with systolic heart failure (HF) aged >60 years, were included. They were randomized to the nurse-based outpatient clinic or to the patients´ general practitioners (GP). The aim was to assess effects of a nurse-based management program intended to increase the knowledge of the HF disease and its self-care and relate the results to gender and cognitive function. The results showed that the nurse-based outpatient clinic has an important role in patient education, and increases patients´ knowledge about self-care and the disease. The results indicate that females have more to gain than men from such management programs. Patients demonstrating signs of cognitive dysfunction when in hospital did also benefit.

In Paper II 224 patients, aged <75 years suffering from an acute AMI or who had underwent coronary artery by-pass grafting, were randomized to intervention (an expanded cardiac rehabilitation program) or to control (usual care). The aim was to investigate the effect of an expanded cardiac rehabilitation program on psychosocial characteristics including depression, anxiety, and quality of life (QoL) in type D and non-type D coronary artery disease (CAD) patients. The results show that an expanded rehabilitation program significantly reduces type D score, improves QoL, and decreases self-estimated depression and anxiety in CAD patients in the highest quartile of type D score.

In Paper III and IV 182 patients with chronic heart failure (CHF) were included and referred to the nurse-based outpatient clinic. They were randomized to intervention (patients decided on how they should be informed and by which information technique) or to control (the nurse decided according to usual routine).

The aim in Paper III was to compare patient-based selection of information with nurse-based selection of information in patients with HF and to evaluate the effects on knowledge acquisition, QoL, visits to the outpatient clinic, drug therapy and readmissions. Patients had fewer visits to the nurse-based outpatient clinic and a trend to a more flexible diuretic regimen, if patients were involved in the decision on how to be informed. Both groups increased QoL, knowledge their doses of relevant medication, and readmissions did not differ between the two groups.

The aim in Paper IV was to compare patient-based and nurse-based New York Heart Association (NYHA) classification and its relation to grade of depression and knowledge acquisition in patients with HF. The results show a mismatch between the NYHA classifications performed by patients respectively by the nurse. Furthermore, patients in a depressed mood at baseline had more clinical events during the first year after hospitalization due to CHF. However, there was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood.

The conclusion is that information given at a nurse-based outpatient clinic has an important role in patient education. Females and patients with in-hospital cognitive dysfunction had the greatest gains Patients who are involved in the decision on how to be informed had fewer visits to the nurse-based outpatient clinic. The fewer visits did not affect knowledge, QoL, readmissions, or medical treatment in a negative way. Patients assessed a higher NYHA class than a nurse. Patients who were depressed had an increased incidence of clinical events during the first year after hospitalisation due to HF. There was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood. An expanded rehabilitation program significantly reduces type D score, improves quality of life, and decreases self-estimated depression and anxiety in patients with CAD in the upper quartile of type D score.