Nurse-led interventions in heart failure care: Patient and nurse perspectives Tialda Hoekstra a, ⁎ , Ivonne Lesman-Leegte a , Martje van der Wal a , Marie Louise Luttik a , and Tiny Jaarsma b a Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands b Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden Received 22 June 2009; received in revised form 18 January 2010; accepted 28 January 2010 Available online 4 March 2010 Abstract Background: Perspectives of nurses and patients on the intensity and content of disease management programmes (DMPs) in heart failure are seldom addressed but are important in optimizing these programmes. Aim: To describe the perspectives of patients and nurses on delivered care in two DMPs. Methods: In total 442 patients (62% male; age 68 ± 12 years; LVEF 33% ± 14), assigned to the intervention groups of the Coordinating Study Evaluating Outcomes of Advising and Counselling in HF (COACH), and 32 registered nurses, completed questionnaires on satisfaction with the intensity and components of the DMPs. Results: In spite of large differences in intensity and components, patients were satisfied with the content of both DMPs. In patients (NYHA III–IV), treatment and educational goals were more often achieved in those who received intensive support, compared to patients who received basic support (85% vs. 70%). Patients and nurses perceived that most home visits were adding significant value to the HF care, while 12% of the home visits were perceived as unnecessary by the nurses. Conclusion: Patients and nurses did not perceive the intense DMP as an emotional and physical burden for themselves. Patients with severe HF might be in need of more support to achieve optimal treatment and educational goals. © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved. Keywords: Heart failure; Disease management programmes; Nurse perspectives; Patient perspectives; Satisfaction 1. Introduction Hospital readmission and mortality rates remain high in patients with heart failure (HF), despite improved pharmaco- logical interventions [1]. Reversible factors such as a lack of understanding of HF, poor treatment compliance, inadequate follow-up and difficulty in having access to specific HF care in-hospital are related to poor outcomes. As a consequence HF disease management programmes (DMPs) have been devel- oped. [2,3]. In the guidelines of the European Society of Cardiology (ESC), it is stated that a DMP should have several specific components defined as 9 key characteristics and every HF patient should have access to a DMP [1]. Recent meta-analyses support the finding that most DMPs are effective and reduce readmissions, length of hospital stay, costs of care, mortality and improve quality of life [4,5]. Although no studies are known to investigate the optimal model for specific patient groups, the ESC HF guidelines recommend to distinguish in intensity of DMPs between patients with mild HF (New York Heart Association (NYHA) functional class II) and patients with severe HF (NYHA functional class III–IV), in which the latter should receive more intensive counselling. Until now studies have identified effective components [6] but patient and nurse perspectives are not evaluated. It is unknown what the opinions of the nurses are about the different components in terms of effectiveness, invested time or emotional burden. Also, from a patient's point of view, it is unclear whether they perceive their care as being too intensive European Journal of Cardiovascular Nursing 9 (2010) 226 – 232 www.elsevier.com/locate/ejcnurse ⁎ Corresponding author. Tel.: +31 50 3612355; fax: +31 50 3614391. E-mail address: t.hoekstra@thorax.umcg.nl (T. Hoekstra). 1474-5151/$ - see front matter © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejcnurse.2010.01.006