the evaluation of the impact of nursing counselling

The Evaluation of the Impact of Nursing Counselling Intervention on the Quality of Life of Patients with Heart Failure, Systematic Review

1

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Received: Feb 23, 2021Accepted: Mar 16, 2021Published Online: Mar 18, 2021Journal: Annals of Cardiology and Vascular MedicinePublisher: MedDocs Publishers LLCOnline edition: http://meddocsonline.org/Copyright: © Petaloti S (2021). This Article isdistributed under the terms of Creative Commons Attribution 4.0 International License

*Corresponding Author(s): Stergiani PetalotiIntensive Care Unit, Serres General Hospital, 62100 Serres, Greece. Email: [email protected]

Annals of Cardiology and Vascular Medicine

Open Access | Research Article

Cite this article: Petaloti S, Kiosses A. The Evaluation of the Impact of Nursing Counselling Intervention on the Quality of Life of Patients with Heart Failure, Systematic Review. Ann Cardiol Vasc Med. 2021: 4(1); 1047.

ISSN: 2639-4383

Abstract

Introduction: Heart Failure (HF) is a chronic de�ilitat�HF) is a chronic de�ilitat�) is a chronic de�ilitat�ing syndrome, which is associated with negative effects on �oth the physical/physical, mental, and socioeconomic di�mension of patients suffering from it. This syndrome is as�sociated with high mor�idity and mortality and despite the introduction of new treatment protocols the prognosis con�tinues and remains poor. Patients with the syndrome expe�rience repeated hospitalizations, long�term re�hospitaliza�tions, with symptoms and signs, which exhaust them and all of them, affect their Quality of Life (QofL). In recent years, special attention has �een paid to the QofL with many stud�ies internationally investigating and examining the effect of Non�Pharmacological Interventions, managed �y Nurses on their improvement and their effect on the QofL of these pa�tients.

The purpose of this Systematic Review (SR) was to evalu�ate the effect of Counseling Intervention �y health profes�sionals Nurses on the care of patients with HF, �y improving their self�care, through empowerment, with training pro�grams on discharge from the hospital., in their transfer from the hospital to the home and then their follow�up at specific intervals.

Material and methods: Articles were searched in the Pu�med (Medline) data�ases and in the Google Scholar da�ta�ase. The matching of the keywords, the com�ination of the individual keywords used during the search in the data��ases was the following: (“Advisory intervention” OR “nurs�ing advisory intervention” OR “nursing counselling” OR “nursing interventions” OR “nurse � led interventions ”OR“ counselling ”OR“ mutual goal setting ”OR“ goal setting ”OR“ supportive educational strategies ”OR“ supportive interven�tions ”OR“ supportive strategies ”OR“ educational inter�ventions ”OR“ educational interventions ”OR“ educational strategies ” OR “advice” OR “intervention”) AND “quality of life” AND (“heart failure” OR “cardiac failure” OR “cardiac reha�ilitation”).

Stergiani Petaloti1*; Anestis Kiosses2

1Intensive Care Unit, Serres General Hospital, 62100 Serres, Greece.2Postgraduate student University of Piraeus, Greece.

Keywords: Heart Failure; Non�Pharmacological Management; Quality of Life; Disease Management Programs; Nursing Coun�selling.

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2Annals of Cardiology and Vascular Medicine

Results: The Non�Pharmacological Management pro�grams, managed �y specialist nurses, with the counselling, educational intervention, help to identify disorders �efore the deregulation of the HF and the admission of the patient to the hospital, to strengthen him and his caregivers, �ut no correlation was o�served �etween the improvements of health�related QofL.

Conclusions: There is complexity, diversity of these pro�grams, �oth to determine the type of intervention �y coun�selling/educational nursing, and the time, duration of the intervention, intensity, content of management programs, as well as the duration of follow up, �ut also in setting up the team of health professionals. Further studies are needed to evaluate the results of Non�Pharmacological Management of patients with HF in health related to time, duration of follow�up, and esta�lishment of the interdisciplinary team, intensity and content of management programs to docu�ment its effectiveness. Of these programs.

Introduction

HF is a syndrome and not a disease, with an increasing preva�lence and incidence as the population ages. It is the most rapid�ly growing cardiovascular condition, driven �y the modern way of life, the growing life expectancy, the aging population [1]. HF syndrome is the leading cause of hospitalization for people over the age of 65. One in five people aged 40 and over will develop HF during their lifetime [2]. HF leads to admissions, hospitaliza�tions, re�hospitalizations, which in America and Europe reach 1 to 2% of all admissions [3]. Approximately 1 in 4 patients diag�nosed with HF will �e re�admitted within the next 30 days after discharge [4]. 30% of patients with HF require re�admission / re�hospitalization in the next 60 to 90 days [3,5]. The flow of re�admissions, re�admissions of patients with HF in the 6 months after discharge from the hospital is reported to �e 25% in Eu�rope and 27% in the USA and Japan [6�8].

Each treatment changes the natural history of the syndrome, dou�ling and tripling mortality. Hospitalizations, re�hospitaliza�tions are responsi�le for 70% of the cost of HF. A patient with HF is estimated to have 3�4 re�admissions per year [9]. The effec�tive treatment of those who leave the hospital with the diagno�sis of HF, should start from the hospitalization and continue in the phase when the patient is now am�ulatory and will include a multifaceted approach, with detailed instructions from diet, exercise, diet, fluid management, psychosocial support, �ut also continuous supervision for the early identification of signs of deterioration. The transition phase from hospital to home, according to studies, is the most vulnera�le period for patients with HF, with a high risk of death, especially in the first weeks [10].

This syndrome is characterized �y poor QofL of these pa�tients, due to the symptoms and signs of the syndrome, re�peated re�admissions, re�hospitalizations, social isolation that the syndrome �rings to these patients, due to severe symptoms that make it difficult and tiring for patients, �ut also comor��idities, as well as depressive symptoms, which depression is a common comor�idity in patients with HF, which has �een as�sociated with worsening prognosis [11,12].

One of the main causes for re�admissions is lack of self�care management, non�compliance with medication, lack of, con�trol of the management of early symptoms and signs of HF and

timely feed�ack to prompt treatment and inclusive treatment. timely visit to the hospital for additional health care [13].

Several studies, clinical trials have �een designed since the mid�1990s to investigate the improvement of self�care, enhanc�ing and strengthening the self�management of patients with HF through non�pharmacological management programs, led �y specialist nurses, aiming to reduce re�admissions. , through the acquisition of skills, a�ilities for the early detection of symp�toms and signs of HF deregulation, improving survival with the ultimate goal of improving their health�related QofL [13�16].

However, some patients with HF, which is a sufficient per�centage, can not for many reasons, factors, so demographic, clinical, socioeconomic acquire the necessary, adequate self�management skills of HF, despite their participation in a train�ing program, counselling , a non�pharmacological management program, as patients with HF are elderly, who, as mentioned a�ove, suffer from comor�idities with severe symptoms, which need daily support, �oth from the family, caregivers, and medi�cal intervention [11].

With the necessary, necessary feed�ack for the evaluation of the health status of the patients with HF and the appropri�ate coordination of their health care, with the appropriate non�pharmacological management program, with the appropriate cooperation of the interdisciplinary team, the holistic�interdis�ciplinary are identified and treated. severity of the health status of patients with HF. Empowering the same patients with HF, if possi�le, as well as family and caregivers from the interdisci�plinary team, with counselling, education, nursing approach, monitoring, enhancing, supporting self�management skills and early detection and progression of symptoms take collective ac�tion to address the pro�lems associated with deterioration, al�ways aiming to improve as much as possi�le the health�related QofL of these patients [17].

Purpose

The purpose of this Systematic Review was to evaluate, to investigate the effect of Counselling Intervention �y health pro�fessionals, Nurses, on the care of patients with HF, �y improving their self�care, through their empowerment, with educational programs upon their discharge from the hospital., in their trans�fer from the hospital to the home and then their follow�up at specific intervals.

Material and methods

For the more complete study of the effect of the nursing counselling intervention on the QofL of the patients with HF, an SR of the studies related to the specific su�ject was carried out. The SR is an extremely important method that aims to find and analyze all research related to an issue and meet specific criteria set �y the researcher himself. In the search strategy of the surveys included in the review, a research tool was used, as an organizational framework for ranking the terms �ased on the main topics of the search query. One such tool is the PICO tool, which focuses on 4 main categories [18]:

Population,

Intervention,

Comparison and

Outcomes.

In the present review, the population corresponds to the

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patients with HF, the intervention corresponds to the nursing counselling intervention, there is no comparison in this search and the results correspond to the QofL. For each of these cat�egories, all possi�le, different keywords were indexed and com��ined with the words “AND” and “OR” in the search, which was performed in two valid data�ases: the Pu�med data�ase (Medline) and the Google Scholar data�ase. The matching of the keywords with each category and the com�ination of the individual keywords used in the search in the data�ases was as follows: (“Advisory interventi on” OR “nursing advisory interven�(“Advisory intervention” OR “nursing advisory interven�tion” OR “nursing counseling” OR “nursing interventions” OR “nurse – led interventions” OR “counseling” OR “mutual goal setting” OR “goal setting” OR “supportive educative strategies” OR “supportive interventions” OR “supportive strategies” OR “educative interventions” OR “educational interventions” OR “educative strategies” OR “advice” OR “intervention”) AND “quality of life” AND (“Heart Failure” OR “Cardiac Failure” OR “Cardiac Reha�ilitation”). Additionally, a secondary article search was performed through the �i�liographic references of the original search articles. The material of this SR were ar�ticles of the last fifteen years, which explored the content of the counselling programs of the nursing intervention, as well as the participation of the patients with HF in the various forms of these programs.

Criteria for entry and exclusion of studies

After a num�er of studies �ased on the index words used in the data�ase search, the final selection of the surveys included in this SR was conducted on the �asis of entry and exclusion criteria data. More specifically, the main criteria for entering the surveys in the review were the following:

1. Articles must have �een pu�lished in English or Greek.

2. The articles should have �een pu�lished within the last 15 years (year 2004 to year 2019), in order to focus the review on the latest research results.

3. The articles should �e directly related to the effect of nursing counselling / educational interventions on the QofL of patients with HF.

Respectively, the main criteria for excluding investigations from SR were the following:

1. Articles that were not pu�lished in English or Greek.

2. Articles pu�lished �efore 2004.

3. The articles that were not directly related to the effect of nursing counselling / educational interventions on the QofL of patients with HF.

Search Number

Key-words - Search Key-wordsNumber of Inquiries Found

in Pubmed Database

Population: Patients with HF #1 “Heart failure” OR “Cardiac failure” OR “cardiac reha�ilitation” 212.200

Intervention: Nursing Counseling Intervention

#2

“Advisory intervention” OR “nursing advisory intervention” OR “nursing counseling” OR “nursing interventions” OR “nurse – led interventions” OR “counseling” OR “mutual goal setting” OR “goal setting” OR “supportive educative strategies” OR “supportive interventions” OR “supportive strategies” OR “educative interventions” OR “educational interventions” OR “educative strategies” OR “advice” OR “intervention”

776.590

Comparison #3 � �

Outcomes: Quality of Life #4 “quality of life” 310.772

Combination #5 #1 AND #2 AND #3 AND #4 756

Iden

tifica

tion

Files found by searching databases (n=756 )

Scre

enin

g El

igib

ility

In

clude

d

Additional files found through other sources (n=6)

Files after removing duplicate file (n=750)

s

Files examined (n=750)

Rejected files (n=681)

Full-text files evaluated for their suitability

(n=69)

Full text files rejected based on exclusion criteria

(n=49)

Studies included in the Systematic Review

(n=20)

PRISMA 2009 Flow Diagram

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Doug

hert

y et

al,

[37]

USA

141

pati

ents

with

HF

and

9 h

ealth

ca

re p

rovi

ders

1. D

iagn

osis

of H

F w

ith re

duce

d ej

ectio

n fr

actio

n (H

FrEF

) le

ss th

an o

r equ

al to

40%

or H

F w

ith re

tain

ed e

jecti

on

frac

tion

(HFp

EF) l

ess t

han

50%

2.

Com

pleti

on o

f out

patie

nt v

isit w

ithin

the

last

6 m

onth

s w

ith a

sche

dule

d fo

llow

�up

visit

3.

A�i

lity

to re

ad, s

peak

and

writ

e in

Eng

lish

Inte

rven

tion

to d

eter

�m

ine

the

goal

s and

nex

t st

eps o

f the

trea

tmen

t of

HF.

Inte

rvie

ws w

ith o

pen�

ende

d qu

estio

ns

a�ou

t the

pati

ent's

exp

erie

nce

of th

e in

terv

entio

n, th

e go

als o

f car

e, th

e ac

cept

ance

of t

he st

ruct

ure

and

char

�ac

teris

tics o

f the

inte

rven

tion,

the

qual

�ity

of t

he d

iscus

sion

with

the

heal

th

care

pro

vide

r and

the

sugg

estio

ns fo

r im

prov

ing

this

inte

rven

tion

6 m

onth

s

Patie

nts'

�ene

fits f

rom

this

nurs

ing

inte

rven

tion

incl

uded

en

hanc

ed c

omm

unic

ation

with

the

heal

th c

are

prof

essio

nal

and

his o

r her

fam

ily m

em�e

rs, i

ncre

ased

con

fiden

ce in

hav

ing

an h

ones

t and

mea

ning

ful d

iscus

sion

with

the

heal

th c

are

prov

ider

, and

con

stan

t upd

ating

and

upg

radi

ng o

f his

/ her

kn

owle

dge

HF. T

he �

enefi

ts o

f the

hea

lth p

rofe

ssio

nals

from

th

is in

terv

entio

n w

ere

the

faci

litati

on o

f the

disc

ussio

n w

ith

the

patie

nt a

nd th

e le

arni

ng o

f new

info

rmati

on a

�out

the

goal

s and

val

ues o

f the

pati

ent.

Bern

occh

i et

al,

[37]

Italy

Is n

ot m

entio

ned

112

patie

nts

with

chr

onic

he

art f

ailu

re

and

chro

nic

o�st

ructi

ve

pulm

onar

y di

seas

e

1. C

onfir

med

dia

gnos

is of

chr

onic

HF

and

chro

nic

o�st

ruc�

tive

pulm

onar

y di

seas

e (C

OPD

) 2.

Pati

ents

shou

ld h

ave

retu

rned

hom

e aft

er h

ospi

taliz

a�tio

n 3.

Pati

ents

shou

ld n

ot h

ave

phys

ical

acti

vity

lim

ita�

tions

due

to n

on�c

ardi

ac o

r pul

mon

ary

cond

ition

s 4.

Pati

ents

had

to h

ave

a lif

e ex

pect

ancy

of m

ore

than

6

mon

ths

5. P

atien

ts h

ad to

hav

e m

enta

l cla

rity.

Inte

grat

ed Te

lere

ha�

�ilit

ation

Hom

e � B

ased

Pr

ogra

m, T

erea

� � H

BP

6MW

T, C

AT, M

LHFQ

, PAS

E, M

RC,

Bart

hel

6 m

onth

s

Patie

nts'

Qof

L (p

val

ue =

0 in

the

CAT

tool

, p�v

alue

= 0

.000

7 in

th

e M

LHFQ

tool

), as

wel

l as d

yspn

oea

(p v

alue

= 0

.05)

, disa

�il�

ity (p

val

ue =

0.0

006)

and

phy

sical

acti

vity

(p v

alue

= 0

.001

5),

impr

oved

sign

ifica

ntly,

onl

y in

the

grou

p th

at re

ceiv

ed th

e nu

rsin

g in

terv

entio

n, w

hile

the

aver

age

time

for h

ospi

taliz

a�tio

n or

dea

th w

as lo

nger

in th

e ca

se o

f the

inte

rven

tion

grou

p (1

13.4

day

s vs.

104

.7 in

the

cont

rol g

roup

).

Ng

& W

ong

[38]

Chin

a3

84 p

atien

ts w

ith

end�

stag

e HF

.

1. A

�ilit

y to

com

mun

icat

e 2.

A�i

lity

to c

omm

unic

ate

�y te

leph

one

3. A

ccom

mod

ation

in th

e ar

ea th

at se

rved

the

rese

arch

4.

Com

�ina

tion

of tw

o of

the

follo

win

g cr

iteria

: (a)

chr

onic

HF

with

func

tiona

l cla

ss N

YHA

III o

r IV,

repe

ated

hos

pita

li�za

tion

(mor

e th

an o

r equ

al to

2 re

�adm

issio

ns in

the

last

6

mon

ths )

, due

to H

F�re

late

d sy

mpt

oms,

the

pres

ence

of

phy

sical

or p

sych

olog

ical

sym

ptom

s, li

fe e

xpec

tanc

y of

on

e ye

ar b

ased

on

the

doct

or

Nur

sing

palli

ative

in

terv

entio

n fo

r cou

n�se

ling

and

follo

w�u

p of

pa

tient

s with

HF.

Ερω

τημα

τολό

γιο

MQ

OL

– HK

(“M

cGill

Q

ualit

y of

Life

Que

stion

naire

– H

ong

Kong

”), ε

ργαλ

είο

CHQ

– C

, κλί

μακα

εκ

τίμη

σης

σ�μ�

τωμ�

τω�

ESAS

(“Ed

� σ

�μ�τ

ωμ�

τω�

ESAS

(“Ed

�σ�

μ�τω

μ�τω

� ES

AS (“

Ed�

ESA

S (“

Ed�

ESAS

(“Ed

� (“

Ed�

Ed�

mon

ton

Sym

ptom

Ass

essm

ent S

cale

”),

κλίμ

ακα

PPS

(“Pa

lliati

ve P

erfo

rman

ce

Scal

e”),

εργα

λείο

ZBI

(“Za

rit B

urde

n In

terv

iew

”)

3 m

onth

s

Ther

e w

as a

stati

stica

lly si

gnifi

cant

diff

eren

ce in

the

effec

ts

�etw

een

the

two

grou

ps, w

ith th

e in

terv

entio

n gr

oup

havi

ng

a sig

nific

antly

hig

her o

vera

ll Q

ofL

scor

e th

an th

e co

ntro

l gro

up

(p =

0.0

16).

In c

ontr

ast,

ther

e w

ere

no si

gnifi

cant

diff

eren

ces

in e

ffect

s �et

wee

n th

e tw

o gr

oups

in te

rms o

f sym

ptom

s and

fu

nctio

nal s

tatu

s ove

r a 1

2�w

eek

perio

d. T

he in

terv

entio

n gr

oup

show

ed si

gnifi

cant

ly h

ighe

r lev

els o

f sati

sfac

tion

(p =

0.

001)

and

sign

ifica

ntly

low

er c

areg

iver

wor

kloa

d (p

= 0

.024

) th

an th

e co

ntro

l gro

up o

ver a

tota

l per

iod

of 3

mon

ths.

Abba

si e

t al

, [39

]Ira

n1

111

patie

nts

with

chr

onic

HF.

1. D

iagn

osis

of H

F �y

a c

ardi

olog

ist

2. A

�ilit

y to

spea

k an

d w

rite

in F

arsi

3. A

�ilit

y to

use

a c

ompu

ter �

y th

e pa

tient

him

self

or �

y a

mem

�er o

f his

fam

ily

Self�

man

agem

ent t

rain

�in

g pr

ogra

m fo

r pati

ents

w

ith c

hron

ic H

F.

Que

stion

naire

Qof

L in

the

Irani

an e

di�

tion

IHF

� QoL

(“Ira

nian

Hea

rt F

ailu

re

Qua

lity

of L

ife”)

3 m

onth

s

Stati

stica

lly si

gnifi

cant

diff

eren

ces w

ere

o�se

rved

�et

wee

n th

e m

ultim

edia

gro

ups a

nd th

e m

ultip

le m

etho

ds in

term

s of p

ost�

inte

rven

tion

Qof

L, c

ompa

red

to th

e co

ntro

l gro

up (p

<0.

001

and

p =

0.00

2, re

spec

tivel

y). S

tatis

tical

ly si

gnifi

cant

diff

eren

ces

wer

e al

so o

�ser

ved

�etw

een

the

two

grou

ps o

f int

erve

ntion

s in

term

s of k

now

ledg

e di

men

sion

and

self

� effe

ctive

ness

(p =

0.

047)

. In

cont

rast

, no

stati

stica

lly si

gnifi

cant

diff

eren

ces w

ere

o�se

rved

�et

wee

n th

e tw

o in

terv

entio

n gr

oups

with

resp

ect t

o th

e ot

her a

spec

ts o

f the

indi

vidu

al Q

ofL.

MedDocs Publishers


El –

Ja

wah

ri et

al

, [31

]Bo

ston

734

6 pa

tient

s w

ith H

F

1. A

ge 6

4 ye

ars a

nd o

ver

2. A

�ilit

y to

pro

vide

con

scio

us c

onse

nt

3. A

�ilit

y to

com

mun

icat

e in

Eng

lish

4. S

tand

ard

diag

nosis

of a

dvan

ced

HF w

ith li

mite

d pr

ogno

sis

Nur

sing

inte

rven

tion

coun

selin

g an

d su

ppor

t fo

r ser

ious

dec

ision

m

akin

g an

d ca

re p

lan�

ning

Que

stion

naire

with

que

stion

s a�o

ut

dem

ogra

phic

/ pe

rson

al c

hara

cter

istics

an

d th

e ca

tego

ries o

f car

e th

ey c

hoos

e3

mon

ths

In th

e in

terv

entio

n gr

oup,

51%

of p

artic

ipan

ts c

hose

com

fort

ca

re, 2

5% li

mite

d ca

re, 2

2% li

fe�p

rolo

ngin

g ca

re, a

nd 2

% w

ere

unsu

re o

f whi

ch d

ecisi

on to

mak

e. R

espe

ctive

ly, in

the

cont

rol

grou

p, th

e pe

rcen

tage

of p

eopl

e w

ho c

hose

com

fort

car

e w

as

equa

l to

30%

, 22%

of p

eopl

e ch

ose

limite

d ca

re, 4

1% li

fe�lo

ng

care

and

7%

said

they

wer

e un

sure

. Pati

ents

in th

e in

terv

en�

tion

grou

p, c

ompa

red

with

pati

ents

in th

e co

ntro

l gro

up, w

ere

mor

e lik

ely

to re

ject

CRP

(p <

0.00

1) a

nd in

tu�a

tion

(p <

0.00

1)

and

had

high

er k

now

ledg

e sc

ores

(p <

0.00

1).

Caja

ndin

g,

[32]

Uni

ted

King

dom

110

0 pa

tient

s w

ith H

F

1. A

ge e

qual

to o

r ove

r 18

year

s 2

. Rec

ent h

ospi

taliz

ation

from

whe

re th

e pa

rtici

pant

s w

ere

colle

cted

3.

Tre

atm

ent f

or h

eart

failu

re a

nd n

ot fo

r oth

er c

omor

��i

ditie

s

Nur

ses g

uide

d co

gniti

ve

/ �eh

avio

ural

ther

apy

Que

stion

naire

MLH

F (“

Min

neso

ta L

iv�

(“M

inne

sota

Liv

�M

inne

sota

Liv

� L

iv�

Liv�

ing

with

Fai

lure

Que

stion

naire

”), R

SES

(“Ro

senb

erg

Self

– Es

teem

Sca

le”)

, CDS

(“

Card

iac

Depr

essio

n Sc

ale”

)

3 m

onth

s

Parti

cipa

nts i

n �o

th g

roup

s had

low

qua

lity

of li

fe a

nd se

lf�es

teem

scor

es a

nd m

oder

ate

leve

ls of

dep

ress

ive

sym

ptom

s at

the

�egi

nnin

g of

the

stud

y. A

fter t

he in

terv

entio

n la

sted

a

tota

l of 1

2 w

eeks

, the

par

ticip

ants

who

�el

onge

d to

the

inte

rven

tion

grou

p sh

owed

a si

gnifi

cant

impr

ovem

ent i

n th

eir

qual

ity o

f life

, sel

f�est

eem

and

moo

d co

mpa

red

to th

e ot

her

parti

cipa

nts w

ho re

ceiv

ed o

nly

stan

dard

car

e.

Wan

g et

al,

[33]

Chin

a1

62 p

atien

ts

with

HF

1. D

iagn

osis

of h

eart

failu

re c

lass

II to

IV

2. A

ge 6

0 ye

ars a

nd o

ver

3. T

he st

a�le

con

ditio

n of

pati

ents

4. T

he p

rese

nce

of

typi

cal s

ympt

oms

5. T

he p

rese

nce

of si

gns o

f HF

that

hav

e di

sapp

eare

d aft

er

a tr

eatm

ent

6. T

he p

atien

t's d

ischa

rge

from

the

hosp

ital

Nur

sing

educ

ation

al

inte

rven

tion

�ase

d on

th

e PR

ECED

E m

odel

MLH

FQ, P

HQ –

9, E

HFSc

BS –

9,

ques

tionn

aire

�as

ed o

n th

e PR

ECED

E m

odel

3,5

mon

ths

Ther

e w

as a

sign

ifica

nt im

prov

emen

t in

qual

ity o

f life

, dep

res�

sion,

self�

care

Beh

avio

r, an

d pr

edisp

ositi

on, r

einf

orce

men

t, an

d ac

tivati

on fa

ctor

s in

educ

ation

al d

iagn

osis

and

eval

uatio

n am

ong

patie

nts i

n th

e in

terv

entio

n gr

oup,

as o

ppos

ed to

pa

tient

s in

the

non�

inte

rven

tion

grou

p. si

gnifi

cant

diff

eren

ces.

Pa

tient

s 'Q

ofL

was

sign

ifica

ntly

cor

rela

ted

with

per

sona

l hea

lth

(p v

alue

<0.

001

/ r =

0.4

63) a

nd p

atien

ts' s

elf�c

are

�eha

vior

s (p

valu

e <0

.001

/ r =

0.5

84).

Med

iano

et

al,

[34]

Braz

il1

12 p

atien

ts w

ith

Chag

as h

eart

fa

ilure

1. E

xist

ence

of s

tage

C o

r D C

haga

s car

diom

yopa

thy

2. A

�sen

ce o

f a h

istor

y of

clin

ical

effe

cts d

urin

g th

e la

st

3 m

onth

s

Hear

t reh

a�ili

tatio

n pr

ogra

mSF

� 36

8 m

onth

s

The

re w

ere

signi

fican

t im

prov

emen

ts in

phy

sical

func

tion

(p

= 0.

003)

, phy

sical

role

(p =

0.0

3), a

nd p

hysic

al p

ain

(p =

0.0

2),

as w

ell a

s ove

rall

phys

ical

hea

lth. I

n co

ntra

st, n

o sig

nific

ant

chan

ges w

ere

o�se

rved

in o

ther

are

as o

f Qof

L, a

s wel

l as i

n ov

eral

l men

tal h

ealth

.

Sezg

in e

t al

, [35

]Tu

rkey

190

pati

ents

w

ith H

F

1. A

ge 1

8 ye

ars a

nd o

ver

2. F

uncti

onal

cla

ssifi

catio

n as

NYH

A II

or N

YHAI

II 3

. Writi

ng a

�ilit

y 4.

A�i

lity

to u

nder

stan

d an

d sp

eak

the

Turk

ish la

ngua

ge

5. W

illin

gnes

s to

parti

cipa

te

Nur

sing

coun

selin

g in

terv

entio

n fo

r car

e

SCHF

I (Se

lf�ca

re o

f Hea

rt F

ailu

re In

dex)

, Le

ft ve

ntric

ular

dys

func

tion

scal

e,

hosp

ital a

dmiss

ion

6 m

onth

s

Ther

e w

as a

stati

stica

lly si

gnifi

cant

diff

eren

ce �

etw

een

the

cont

rol g

roup

and

the

inte

rven

tion

grou

p in

term

s of Q

ofL

scor

es (p

<0.

001)

and

self�

care

scor

es (p

<0.

001)

at �

oth

3 an

d 6

mon

ths.

In a

dditi

on, w

hile

the

inte

rven

tion

grou

p re

cord

ed

few

er re

�adm

issio

ns to

the

hosp

ital o

ver a

per

iod

of 3

mon

ths

(p <

0.05

), no

sign

ifica

nt d

iffer

ence

s wer

e o�

serv

ed o

ver a

pe

riod

of 6

mon

ths (

p =

0.05

) �et

wee

n th

e tw

o gr

oups

.

MedDocs Publishers


Kobe

rich

et

al, [

26]

Germ

any

111

0 pa

tient

s w

ith H

F

1. P

atien

ts w

ith L

eft V

entr

icul

ar e

jecti

on fr

actio

n (L

VEF)

le

ss th

an o

r equ

al to

40%

2.

Cla

ss II

to IV

, �as

ed o

n N

YHA

Nur

sing

educ

ation

al

inte

rven

tion

with

tel�

epho

ne m

onito

ring

EHFS

cBS

(“Eu

rope

an H

eart

Fai

lure

Sel

f –

care

beh

avio

r Sca

le”)

, KC

CQ (“

Kans

as c

ity c

ardi

omyo

path

y qu

estio

nnai

re”)

, CD

S (“

Care

Dep

ende

ncy

Scal

e”)

3 μή

�ες

A sig

nific

ant ti

me

effec

t (p

= 0.

0000

9) a

nd a

sign

ifica

nt ti

me

and

inte

rven

tion

inte

racti

on (p

= 0

.043

) wer

e o�

serv

ed in

se

lf�ca

re �

ehav

iour

s. T

he in

crea

se in

impr

ovem

ent i

n se

lf�ca

re

�eha

vior

s was

sign

ifica

ntly

hig

her i

n th

e in

terv

entio

n gr

oup

(3.1

4 vs

. 1.0

4). R

egar

ding

Qof

L, o

nly

a sig

nific

ant e

ffect

of ti

me

was

o�s

erve

d (p

= 0

.000

17),

the

Qof

L of

pati

ents

incr

ease

d aft

er th

e pe

riod

of 3

mon

ths i

n �o

th g

roup

s, �

ut n

o sig

nific

ant

inte

racti

on o

f tim

e an

d in

terv

entio

n w

as o

�ser

ved

(p =

0.2

03).

Clar

k et

al,

[27]

Texa

s1

50 p

atien

ts

with

HF

1. D

iagn

osis

of d

iast

olic

or s

ysto

lic H

F cl

ass I

to II

I �as

ed

on N

YHA

2. A

�ilit

y to

spea

k, re

ad a

nd w

rite

Engl

ish 3

. Will

ingn

ess t

o pa

rtici

pate

in th

is re

sear

ch

4. A

�ilit

y to

surv

ive

inde

pend

ently

at h

ome

5. S

core

of a

t lea

st 2

3 on

the

MM

SE (“

Min

i � M

enta

l Sta

te

Exam

inati

on”)

Nur

sing

inte

rven

tion

trai

ning

and

supp

ort

at h

ome

Que

stion

naire

KCC

Q (“

Kans

as C

ity

Card

iom

yopa

thy

Que

stion

naire

”),

GDS

(“Ge

riatr

ic D

epre

ssio

n Sc

ale”

), Q

uesti

onna

ire M

IA (“

Met

amem

ory

in

Adul

thoo

d Q

uesti

onna

ire”)

, Tes

t HFK

T,

“HF

Knw

oled

ge Te

st”)

, SCH

FI, “

Self

– Ca

re o

f Hea

rt F

ailu

re In

dex”

9 m

onth

s

The

inte

rven

tion

team

show

ed si

gnifi

cant

impr

ovem

ents

in

Qof

L, se

lf�effi

cacy

, fun

ction

al st

atus

/ a�

ility

self�

care

and

se

lf�ca

re k

now

ledg

e. In

�ot

h gr

oups

, the

re w

as a

sign

ifica

nt

impr

ovem

ent i

n de

pres

sion

scor

es.

Wan

g et

al,

[28]

Taiw

an1

92 p

atien

ts

with

HF

1. D

iagn

osis

of fu

nctio

nal c

lass

NYH

A I t

o IV

�y

a ca

rdio

lo�

gist

2.

A�i

lity

to c

omm

unic

ate

in T

aiw

anes

e or

Man

darin

3.

Ful

l con

scio

usne

ss

4. A

ccep

tanc

e of

par

ticip

ation

in th

e re

sear

ch

Supp

ortiv

e, e

duca

tiona

l nu

rsin

g ca

re p

rogr

am

PFS

(“Pi

per f

atigu

e sc

ale”

), M

LHFQ

(“

Min

neso

ta li

ving

with

hea

rt fa

ilure

qu

estio

nnai

re”)

3 m

onth

s

The

resu

lts o

f thi

s stu

dy sh

owed

that

ther

e w

as a

sign

ifica

nt re

�du

ction

in p

atien

t fati

gue

after

3 m

onth

s, w

hile

in th

e co

ntro

l gr

oup,

no

corr

espo

ndin

g ch

ange

s wer

e o�

serv

ed. I

n ad

ditio

n,

the

inte

rven

tion

team

show

ed a

sign

ifica

ntly

gre

ater

redu

ction

in

fatig

ue le

vels

and

a sig

nific

antly

hig

her i

mpr

ovem

ent i

n Q

ofL

after

3 m

onth

s.

Mas

ters

on

Creb

er e

t al

, [29

]U

SA1

67 p

atien

ts

with

HF

1. T

he p

rimar

y or

seco

ndar

y di

agno

sis o

f HF.

2. T

he a

�ilit

y to

spea

k an

d w

rite

Engl

ish

3. A

ge o

ver 1

8 ye

ars

4. T

he a

�ilit

y of

inde

pend

ent s

elf�c

are

5. S

tay

30 m

iles f

rom

Uni

vers

ity H

ospi

tal

6. T

he e

xist

ence

of t

ypic

al sy

mpt

oms o

f HF.

7. T

he e

xist

ence

of e

lem

enta

ry e

duca

tion

Nur

sing

inte

rven

tion

mo�

iliza

tion

thro

ugh

inte

rvie

ws

KCCQ

, SCH

FI, H

FSPS

3 m

onth

sTh

ere

wer

e no

stati

stica

lly si

gnifi

cant

diff

eren

ces �

etw

een

the

two

grou

ps in

term

s of Q

ofL,

phy

sical

sym

ptom

s, se

lf�ca

re

confi

denc

e an

d m

aint

enan

ce o

f sel

f�car

e a�

ility

.

Men

g et

al,

[30]

Germ

any

447

5 pa

tient

s w

ith H

F

1. D

iagn

osis

of c

hron

ic H

F. 2.

Pati

ents

with

Left

Ven

tric

ular

eje

ction

frac

tion

(LVE

F)

less

than

or e

qual

to 4

0% 3

. Cla

ss II

to II

I, �a

sed

on th

e N

ew Y

ork

Hear

t Ass

ocia

tion

(NYH

A)

Self�

man

agem

ent t

rain

�in

g pr

ogra

m fo

cusin

g on

th

e pa

tient

with

HF.

Germ

an v

ersio

n of

the

heiQ

(“He

alth

Ed

ucati

on Im

pact

Que

stion

naire

”),

Kans

as C

ity C

ardi

omyo

path

y Q

uesti

on�

naire

, a G

odin

Lei

sure

� Ti

me

Exer

cise

Q

uesti

onna

ire M

ARS

� D (“

Med

icati

on

Adhe

renc

e Re

port

Sca

le”)

, Ger

man

ve

rsio

n of

the

KCCQ

que

stion

naire

for

mea

surin

g he

alth

�rel

ated

MS

12 m

onth

s

Ther

e w

as a

sign

ifica

nt �

ut sm

all d

iffer

ence

in th

e im

prov

e�m

ent o

f pati

ents

' sel

f�man

agem

ent a

�ilit

y �e

twee

n th

e tw

o gr

oups

(p <

0.05

). Si

gnifi

cant

smal

l effe

cts w

ere

o�se

rved

on

trea

tmen

t sati

sfac

tion

and

sym

ptom

regu

latio

n ov

er 6

mon

ths,

as

wel

l as o

n ph

ysic

al a

ctivi

ty /

a�ili

ty a

nd sy

mpt

om re

gula

tion

after

12

mon

ths (

p <0

.05)

. Afte

r 6 a

nd 1

2 m

onth

s, a

sign

ifica

nt

impr

ovem

ent w

as o

�ser

ved

in Q

ofL

in �

oth

grou

ps, a

nd in

the

inte

rven

tion

grou

p th

e im

prov

emen

t was

hig

her,

�ut t

here

was

no

stati

stica

lly si

gnifi

cant

diff

eren

ce �

etw

een

the

two

grou

ps

(p =

0.3

3).

MedDocs Publishers


Auth

ors /

Ye

arCo

untr

yN

umbe

r of C

ente

rs

whe

re th

e re

sear

ch

was

con

duct

ed

Sam

ple

Num

-be

rSa

mpl

e Fe

atur

esIn

terv

entio

nsO

utco

mes

Stud

y du

ratio

n (in

m

onth

s)M

ain

Resu

lts

Scott

et a

l, [2

0]U

SA2

88 p

atien

ts

with

HF

1. P

rimar

y di

agno

sis o

f HF.

2. A

ge o

ver 1

8 ye

ars,

3. U

nder

stan

ding

and

spea

king

the

Engl

ish la

ngua

ge.

Com

mon

goa

l de�

limita

tion

inte

rven

tion,

ed

ucati

onal

supp

ort

inte

rven

tion,

pla

ce�o

nu

rsin

g in

terv

entio

n

MHI

– 5

, QLI

)6

mon

ths

The

leve

ls of

men

tal h

ealth

of m

ost p

artic

ipan

ts, r

egar

dles

s of

grou

p, w

ere

low

er th

an th

e va

lue

of th

e ge

nera

l pop

ulati

on

(74.

74),

�ut s

igni

fican

tly h

ighe

r lev

els o

f men

tal h

ealth

wer

e pr

esen

ted

�y th

e gr

oup

that

rece

ived

the

inte

rven

tion

of d

e�m

arca

tion

of c

omm

on g

oals

after

6 m

onth

s (p

valu

e =

0.00

3).

Sign

ifica

nt c

hang

es in

Qof

L w

ere

o�se

rved

in th

e gr

oups

of

dem

arca

tion

of c

omm

on g

oals

and

educ

ation

al su

ppor

t.

Mar

tens

-so

n et

al,

[21]

Swed

en8

153

patie

nts

with

HF

1. D

iagn

osis

of H

F, �a

sed

on ra

diog

raph

ic fi

ndin

gs,

echo

card

iogr

am o

r pre

senc

e of

typi

cal s

igns

and

sym

p�to

ms

2. A

ge o

ver 1

8 ye

ars 3

. NYH

A cl

ass I

I to

IV

4. A

ccom

mod

ation

in a

n ar

ea th

at se

rves

the

rese

arch

Nur

sing

educ

ation

al

inte

rven

tion

for t

he p

ur�

pose

of i

nfor

min

g an

d ed

ucati

ng p

atien

ts w

ith

HF a

nd th

eir f

amili

es

Que

stion

naire

SF

� 36,

Zun

g De

pres

sion

Scal

e (“

Zung

Sel

f � ra

ting

Depr

essio

n Sc

ale”

)12

mon

ths

The

effec

ts o

f thi

s int

erve

ntion

wer

e lim

ited.

Sig

nific

ant d

iffer

�en

ces w

ere

foun

d on

ly in

the

phys

ical

dim

ensio

n / a

�ilit

y of

Q

ofL

and

in p

atien

ts' d

epre

ssio

n. A

t 3 a

nd 1

2 m

onth

s of f

ollo

w�

up, t

he in

terv

entio

n gr

oup

mai

ntai

ned

signi

fican

tly h

ighe

r IB

and

signi

fican

tly lo

wer

leve

ls of

dep

ress

ion

than

the

cont

rol

grou

p, e

spec

ially

am

ong

wom

en.

Stro

mbe

rg

et a

l, [2

2]Sw

eden

515

4 pa

tient

s w

ith H

F1.

Pa

tient

s with

HF

Com

pute

r��as

ed

nurs

ing

educ

ation

in

terv

entio

n

Que

stion

s a�o

ut p

atien

t kno

wle

dge

and

com

plia

nce,

EQ

� 5D

que

stion

naire

(E

uroQ

ol)

6 m

onth

s

Patie

nts'

know

ledg

e in

crea

sed

signi

fican

tly in

�ot

h gr

oups

aft

er 1

mon

th, �

ut th

e in

terv

entio

n gr

oup

tend

ed to

show

m

ore

know

ledg

e th

an th

e co

ntro

l gro

up (p

= 0

.07)

. Also

, the

in

crea

se in

kno

wle

dge

was

stati

stica

lly si

gnifi

cant

ly h

ighe

r in

the

inte

rven

tion

grou

p aft

er 6

mon

ths (

p =

0.03

). N

o sig

nific

ant

diffe

renc

es w

ere

o�se

rved

�et

wee

n th

e tw

o gr

oups

in te

rms

of th

e de

gree

of c

ompl

ianc

e w

ith th

e tr

eatm

ent,

Qof

L an

d se

lf�ca

re. W

omen

show

ed st

atisti

cally

sign

ifica

ntly

low

er Q

ofL

than

men

(p =

0.0

001)

.

Cruz

et a

l, [2

3]Br

azil

141

2 pa

tient

s w

ith H

F1.

Age

18

year

s and

ove

r 2.

Irre

vers

i�le

HF

for a

t lea

st 6

mon

ths

Trai

ning

inte

rven

tion

and

care

coo

rdin

ation

of

the

HF.

MLW

HFQ

(“M

inne

sota

livi

ng w

ith h

eart

fa

ilure

que

stion

naire

”)72

mon

ths

Ther

e w

ere

signi

fican

t im

prov

emen

ts in

the

inte

rven

tion

grou

p in

term

s of o

vera

ll Q

ofL

scor

e, p

hysic

al fa

ctor

/ fu

nctio

nal

capa

city

, em

otion

al fa

ctor

and

oth

er q

uesti

ons,

com

pare

d to

th

e co

ntro

l gro

up. I

n ad

ditio

n, th

e em

otion

al fa

ctor

impr

oved

ea

rlier

in th

e in

terv

entio

n gr

oup

com

pare

d to

the

cont

rol

grou

p. F

inal

ly, Q

ofL

was

not

ass

ocia

ted

with

spec

ific

situa

tions

/ e

vent

s afte

r the

com

pleti

on o

f the

inte

rven

tion.

Wan

g et

al,

[24]

Taiw

an1

27 p

atien

ts

with

HF

1. In

depe

nden

ce o

f pati

ents

' mov

emen

t 2.

Men

tal c

larit

y of

pati

ents

3.

A�i

lity

to c

omm

unic

ate

with

pati

ents

in T

aiw

anes

e or

Ch

ines

e 4

. Pati

ents

' will

ingn

ess t

o pa

rtici

pate

in th

is re

sear

ch

5. W

ritten

con

sent

of t

he p

artic

ipan

ts

Nur

sing

trai

ning

inte

r�ve

ntion

on

self�

care

im

prov

emen

t for

HF

(HFS

C pr

ogra

m)

SDQ

, SM

WT,

SF

� 36

12 m

onth

s

Sign

ifica

nt d

iffer

ence

s wer

e o�

serv

ed in

Qof

L (p

val

ue <

0.05

), fu

nctio

nal c

apac

ity (p

val

ue <

0.01

) and

typi

cal s

ympt

oms o

f HF

(disc

omfo

rt) (

p va

lue

<0.0

1) �

etw

een

the

inte

rven

tion

grou

p an

d co

ntro

l gro

up, �

ut n

o sig

nific

ant d

iffer

ence

s wer

e o�

serv

ed in

the

rate

of h

ospi

taliz

ation

.

Kene

aly

et

al, [

25]

New

Ze

alan

d3

171

patie

nts (

98

rece

ived

the

in�

terv

entio

n an

d 73

�el

onge

d to

the

cont

rol

grou

p)

1. A

ge 1

6 ye

ars a

nd o

ver

2. A

ccom

mod

ation

in th

eir h

ome

3. A

�ilit

y to

com

mun

icat

e in

Eng

lish

4. A

�ilit

y to

phy

sical

ly m

anag

e th

e eq

uipm

ent

Tele

phon

y nu

rsin

g in

terv

entio

n

Que

stion

naire

SF

– 36

, HAD

(“Ho

spita

l An

xiet

y an

d De

pres

sion”

)SC

HFI v

6.2

(“Se

lf ca

re o

f Hea

rt F

ailu

re

Inde

x”),

Que

stion

naire

SGR

Q –

C (“

St G

eorg

e Re

spira

tory

Que

stion

naire

”)

6 m

onth

s

No

signi

fican

t cha

nges

wer

e o�

serv

ed in

Qof

L, d

iseas

e�sp

ecifi

c m

easu

res a

nd se

lf�effi

cacy

, whi

le, o

n th

e co

ntra

ry, s

tres

s an

d de

pres

sion

leve

ls w

ere

signi

fican

tly re

duce

d on

ly in

the

inte

rven

tion

grou

p. In

term

s of p

atien

t exp

erie

nces

, all

of th

e pa

tient

s in

this

stud

y w

ere

positi

ve, a

nd m

any

felt

safe

r and

m

ore

care

d fo

r. Pa

tient

s the

mse

lves

, as w

ell a

s the

ir fa

mili

es,

lear

ned

muc

h m

ore

a�ou

t man

agin

g th

eir c

ondi

tion.

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Bibliography analysis

[20] Conducted an experimental study to examine the ef�fects of nursing interventions that set common goals and sup�port education in the QofL and mental health of patients with HF. For this purpose, a sample of patients with HF was selected from two home health care providers in the Midwest and these patients, after �eing grouped, were randomly divided into three different groups depending on the nursing intervention they received. The first group (Group A) received the interven�tion of delimitation of common goals, the second group (Group B) accepted the intervention of educational support and the third and last group (Group C) received a place�o nursing in�tervention [20]. All participants, regardless of group, received routine management of HF, according to the protocol of home health care organizations, in group B, nurses interacted with pa�tients to examine the impact of HF on their physical and mental health., in strengthening and empowering them, in their edu�cation and to set the goals to �e achieved �ased on the clini�cal guidelines for HF, while in group C, the nurses taught the patients their self�management and at the same time provided them with additional support. The duration of each session was a�out one hour. The main outcome measures were QofL and mental health and were evaluated �efore patient randomiza�tion, 3 months later and 6 months later. Mental health was measured with the tool MHI � 5 ("Mental Health Inventory � 5") and QofL with the cardiac version of the QofL index ("Quality of Life Index", QLI), while the data were statistically processed with the program SPSS. Of the 96 people with HF who were initially approached, 88 were those who eventually participat�ed in the study. Based on the results of the MHI � 5 tool, the mental health levels of most participants, regardless of group, were lower than the value of the general population (74.74), �ut significantly higher levels of mental health were presented �y the group receiving the joint demarcation intervention. after a period of 6 months (p value=0.003) [20]. The levels of total QofL and su��sectors of QofL did not change to a statistically significant level in the place�o group until the 6th month, �ut significant changes were o�served in the groups of common goal delimitation and educational support. More specifically, in the mem�ers of the educational support team, the health and functioning sector improved in 3 months (from 18.14 +/� 5.64 to 20.33 +/� 6.34) and this improvement was maintained in 6 months ( 20.94 +/� 6.68) and the psychosocial / intellectual sector also improved in 6 months (p value=0.04). Respectively, the group of demarcation of common goals marked a significant improvement, �oth in the field of health / function (from 18.54 +/� 5.72 to 24.19 +/� 6), and in the psychosocial / spiritual field (from 24,53 +/� 4.53 to 27.57 +/� 3) after a period of 6 months. Therefore, nursing intervention that sets common goals, as well as the provision of education, seem to �e two methods that sig�nificantly improve the QofL and mental health of patients with HF, when applied for a period of at least 6 months continuously [20].

One year later, the study �y [21]) was pu�lished, which aims to determine the effects of a nurse�led intervention designed to improve the self�management of patients with HF and thus in�crease health�related QofL, and reducing depression. The sam�ple consisted of 153 patients in total, who were divided into two su�groups: the control group and the intervention group. The control group received routine care, which included visits �y nurses and less frequently �y a physician, while the interven�tion team included a training program provided �y nurses, in which the latter were called upon to inform and educate pa�

tients with CHF and their family regarding HF and patient self�management, while at the same time, patients were monitored �y telephone on a monthly �asis for a total of 12 months �y a Primary Health Care (PHC) nurse. The results of this study showed that the effects of this intervention were limited [21]. In particular, significant differences were identified only in the Physical Dimension of the QofL and in the depression of the patients. Comparing the results �etween the two groups over 3 and 12 months, the intervention group maintained signifi�cantly higher QofL and significantly lower levels of depression than the control group, especially among women. Therefore, a nurse�led intervention leads to limited results, although �oth physically and psychologically, the intervention team maintains significantly improved levels of QofL and depression within 12 months of starting the intervention [21].

The main purpose of the study �y [22] was to assess the ef�fects of a training program �ased on computers, knowledge, QofL and patient compliance with HF, with particular emphasis on gender differences. For this purpose, a total of 154 patients, with a mean age of 70 years, were recruited from 5 different clinics and these patients were divided into two groups: the group that received only the standard training and the group that, in addition to the standard training, received additional computer��ased education [22]. According to the results of this study, patients' knowledge increased significantly in �oth groups, after 1 month, �ut the intervention group tended to show higher knowledge than the control group (p=0.07). Also, the increase in knowledge was significantly higher in the inter�vention group after 6 months (p=0.03). In contrast, no signifi�cant differences were o�served �etween the two groups in the degree of adherence to treatment, QofL and self�care. Finally, comparing the two sexes, women showed significantly lower QofL and it did not improve after 6 months, as happened with men (p=0.0001). Therefore, this nursing intervention providing computer education increases the knowledge of patients with HF a�out their self�care, �ut does not significantly improve their QofL and their compliance with medication [22].

In 2010, a prospective, controlled study was pu�lished �y [23], which investigated the impact of a training and coordina�tion program on QofL in patients with HF. The sample consisted of 412 patients, who were divided into two groups: the control group, which received routine care, and the intervention group, which received specific instructions and remote coordination [23]. At some point in the follow�up of patients (3.6 +/� 2.2 years), 6.3% of participants underwent heart transplantation and 31.8% underwent surgery. Based on the results, there were significant improvements in the intervention group in terms of overall QofL score, physical, functional capacity, emotional fac�tor and social dimension, compared to the control group. In ad�dition, the emotional factor improved earlier in the intervention group compared to the control group. Finally, QofL was associ�ated with specific events after the completion of the interven�tion. Overall, this intervention significantly improved the QofL of patients with HF [23],

The main purpose of the quasi�experimental study of [24] was to determine whether patients with HF receiving a health education intervention on improving their self�care for HF self�management HUSK program ("Health education a�out Heart Failure Self � Care"), show higher QofL, �etter functional status, fewer unpleasant symptoms and lower rates of re�admission to the hospital, compared to patients who did not receive the in�tervention. The sample of this study consisted of 27 HF patients

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admitted to 2 general cardiology clinics of a medical center in Taipei, Taiwan, were divided into two su�groups: the first group (control group, 13 people) received routine care and the second group (intervention group, 14 people) received the usual care and the HFSC program. The intervention lasted 4 months, while the total study time was equal with 12 months [24]. The out�come measures evaluated were the Symptom Distress Ques�tionnaire (SDQ), the SMWT (Six Minute Walk Test) to assess the participant's functional status, the SF�36 questionnaire to assess the QofL and the rate of re�admission of patients with HF to the hospital. Based on the results, after 3 months, significant differences were o�served in QofL (p value <0.05), functional capacity (p value <0.01) and symptoms of discomfort, anxiety, shortness of �reath (p value <0, 01), �etween the intervention group and the control group, �ut no significant differences were o�served in the rate of re�admission of patients with HF to the hospital. Therefore, the nursing counseling intervention train�ing on the improvement of self�care, self�management, signifi�cantly improves the symptoms and the functional state � a�ility and improves the QofL of patients with HF. Therefore, nurses should utilize the methods and principles of this nursing edu�cation, counseling intervention to provide improved education and �etter follow�up to this patient group [24].

The main purpose of the study �y [25] was to assess the ef�fect of telemonitoring on health�related QofL, cost, hospital use, self�care and patient experiences, informal caregivers and health professionals. In total, a total of 171 patients were col�lected, who could �e divided according to their disease into three groups: in the group of patients with HF (group A), in the group of patients with Chronic O�structive Pulmonary Disease (COPD) and in the group of patients with Dia�etes. Patients with Diabetes received only the intervention �ecause only the usual care was considered immoral, while the other patients received either the intervention or the standard care (control group). Ac�cording to the results, no significant changes in QofL and self�efficacy were o�served, while, on the contrary, the levels of stress and depression were significantly reduced only in the in�tervention group [25]. No significant differences were o�served in costs, outpatient visits, emergency department visits (ICUs), hospitalization days and hospital admissions. In terms of patient experiences, all patients who participated in this study were positive and many of them felt safer and receiving more health care. Patients themselves, as well as their families, learned much more a�out managing their condition, while health pro�fessionals said they saw several potential �enefits of telecontrol and after some initial technical pro�lems, felt that telecontrol allowed them to monitor effectively more patients. Overall, this particular patient care telephony program leads to a significant improvement in the knowledge and self�care practices of pa�tients, their families and carers, as well as their psychological state, �ut does not significantly improve their IQ [25].

[26] conducted a monocentric, prospective, Controlled Ran�domized Study to evaluate the effects of a nursing education intervention with telephone monitoring of QofL, self�care Be�havior, and dependence on care in patients with Chronic HF. For this purpose, a sample of 110 patients was collected, who were randomly divided into two groups: the control group and the intervention group. In the control group (52 patients), pa�tients received only standard medical treatment, while in the intervention group (58 patients), patients received, in addition to standard medical treatment, training on self�care, self�man�agement of HF, through continuous telephone communication and monitoring [26]. According to the results of this study, a sig�

nificant effect of time (p=0.00009) and a significant interaction of time and intervention (p=0.043) was o�served in self�care �ehaviours, since in �oth groups, self�care �ehaviours improved after a period of 3 months. However, the increase in self�care Behaviour improvement was significantly higher in the inter�vention group (3.14 vs. 1.04). In contrast, with respect to QofL, only a significant effect of time was o�served (p=0.00017), i.e. the QofL of patients with HF increased after the period of 3 months in �oth groups, �ut no significant interaction of time and intervention was o�served ( p=0.203), since no statisti�cally significant higher improvement of QofL was found in the intervention group. Finally, in terms of care dependence, no statistically significant effect of time (p=0.186) was o�served, nor a statistically significant interaction of time and intervention (p=0.676). Therefore, a nursing education intervention through telephone monitoring in patients with HF is a�le to improve overall self�care �ehaviours, �ut not the QofL and the degree of care dependence on other individuals [26].

[27] conducted a Prospective Randomized Study to assess the effects of a home education and support intervention, us�ing strategies that improve health and self�care in adults with CHF. The sample consisted of 50 individuals, who were divided into two groups. The intervention team received a 3�month training and support program, followed �y 3 months of sup�port �y phone and email and another 3 months without any communication �etween patients and competent nurses [27]. The outcome measures of the intervention were health status, including QofL, self�efficacy, functional capacity, psychological dimension, depressive symptoms, improved self�care of pa�tients with HF, and the effectiveness of the intervention was evaluated once at the end of the study. The results showed that the intervention team showed significant improvements in QofL, self�efficacy, functional status, self�care and self�care, self�management knowledge. Also, in �oth groups, there was a significant improvement in depression scores. Therefore, a nursing counseling intervention to educate patients with HF at home significantly improves their QofL, their health status and improves the self�care outcomes of patients with HF [27].

[33] conducted a Controlled Randomized Study to investi�gate the effects of a supportive, educational nursing care pro�gram on QofL and the fatigue of patients with HF. A total of 92 patients with HF were collected, who were randomly divided into two su�groups: the control group, which included a total of 45 participants, and the intervention group, which consisted of a total of 47 participants. Patients in the control group received routine nursing care, which included the provision of written material and oral training �y specialist nurses during the 1st and 3rd weeks after the patient was discharged from the hospital. In contrast, patients in the intervention group received a support�ive nursing education, counseling program, which included as�sessing fatigue, training to improve self�management, self�care, and meeting all disorganization situations [33]. This interven�tion was performed �y a specialized cardiac nurse during four direct contact interviews and three telephone interviews con�ducted for the follow�up of patients with HF. The main outcome measures were QofL and fatigue, and were evaluated, �oth at �aseline and 4 weeks, 8 weeks and 12 weeks after enrolling par�ticipants in the groups. The results of this study showed that there was a significant reduction in the fatigue of patients with HF after 3 months, while in the control group, no correspond�ing changes were o�served. In addition, the intervention team showed a significantly higher reduction in fatigue levels and a significantly higher improvement in QofL after 3 months. There�

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fore, the educational, supportive nursing program to improve self�care is particularly effective in reducing fatigue and increas�ing the QofL of patients with CF [33].

The main purpose of the monocentric, Randomized Control�led Study of Masterson [29] was to investigate the effectiveness of a nursing personalized mo�ilization intervention through in�terviews in QofL, physical symptoms, and self�care �ehaviors among patients with HF. Participants were a total of 67 patients with HF and were divided into two su�groups, the control group that received routine care, and the intervention group that re�ceived a mo�ilization intervention through interviews. During this intervention, a home visit was made and then 3�4 phone calls, over a total period of 3 months, during which the nurses assisted the patients in setting small and larger goals related to the self�care of the patients with HF [29]. To evaluate the ef�fectiveness of the intervention, QofL was examined through the KCCQ (“Kansas City Cardiomyopathy Questionnaire”), self�care through the SCHFI tool, and the physical symptoms associated with HF through the HFSPS scale (“Heart Failure Somatic Per�ception Scale”). The results showed that there were no statisti�cally significant differences �etween the two groups in terms of QofL, physical symptoms, self�care confidence and maintain�ing self�care a�ility. Therefore, the nursing intervention under study did not lead to a significant improvement in QofL and other parameters of patients with HF [29].

In the multicenter, Controlled Randomized Study of [30], the effect of a patient�cantered self�management training program on patients with Chronic Systolic HF compared to standard care training during Cardiac Reha�ilitation was evaluated. The sam�ple collected consisted of 475 patients with HF, who were ran�domly divided into two groups. In the intervention group the patients received a new self�management training program, while in the control group, the patients received the usual care, i.e. a short training program �ased on a lecture. Outcome meas�ures evaluated were self�efficacy, Health�related QofL health self�care Behavior, treatment satisfaction, and these measures were evaluated at �aseline, 6 months and 12 months after the initiation of intervention [30]. The results showed that there was a significant �ut small difference in the improvement of the self�management a�ility of patients with HF �etween the two groups, in the short term (p <0.05). In addition, significant small effects were o�served on treatment satisfaction and symp�tom regulation over 6 months, as well as on physical activity, fitness, and symptom regulation after 12 months (p <0.05). Fi�nally, with regard to QofL, after 6 and 12 months, a significant improvement was o�served in �oth groups and in the inter�vention group the improvement was higher, �ut there was no statistically significant difference �etween the two groups (p = 0.33). Overall, a self�administered program that focuses on the patient with HF may �e more effective in terms of specific self�management outcomes than standard care training, �oth in the short and long term, �ut does not lead to significant differences in the QofL of patients with HF [30].

The Controlled Randomized Study of [31], examined the ef�fect of nursing intervention in providing counseling and support for serious decision making and care planning in patients with CHF. The sample consisted of 246 patients aged 64 years and older with HF, who were divided into two su�groups. In the con�trol group, patients were informed a�out the goals of self�care, such as life extension care, limited care and comfort, self�man�agement care. through an oral description, while in the inter�vention group, patients received the same oral information and

in addition, a video�assisted intervention (6 minutes of video depicting the 3 levels of care) and an advanced self�care pro�gramming list. Based on the results, in the intervention group, 51% of the participants chose comfort care, 25% limited care, 22% life�prolonging care and 2% were unsure a�out which deci�sion to make [31]. Respectively, in the control group, the per�centage of people who chose comfort care was equal to 30%, 22% of people chose limited care, 41% life�long care and 7% said they were unsure. In addition, patients in the intervention group, compared with patients in the control group, were more likely to renounce CRP (p <0.001) and intu�ation (p <0.001) and had higher knowledge scores (p <0.001). . Overall, patients with HF who watched the video were more informed and were more likely to choose their health care �ased on improving their IQ and comfort and in particular, were more likely to choose com�fort care and less likely to choose intu�ation or CRP, compared with patients who received only oral information a�out their self�care goals [31].

[32] conducted a Randomized Controlled Study to evaluate the effectiveness of a nurse�guided cognitive / �ehavioural / ed�ucational intervention in QofL, self�esteem and empowerment of patients with HF. The sample consisted of 100 patients, who were enrolled in either the control group (48 people), which re�ceived routine care, or the intervention group (52 people), which received, in addition to routine care, a nurses�led program. cog�nitive / �ehavioural / counseling intervention, focusing on the patient's education, self�regulation, self�management of the HF, self�care, practice of his skills, reconstruction of his cognitive a�ilities, his empowerment and the development of his men�tal a�ilities [32]. The main outcome measures measured were the QofL, self�esteem and mood of the participants, and these measures were measured immediately �efore and immediately after the intervention. According to the results, participants in �oth groups had low QofL scores and self�esteem and moder�ate levels of depressive symptoms at the �eginning of the study. After the intervention lasting a total of 12 weeks, the partici�pants who �elonged to the intervention group showed a sig�nificant improvement in their QofL, their self�esteem and their mental mood compared to the other participants who received only the standard routine care. Therefore, it is concluded that a nurses�led cognitive / �ehavioural / educational / counseling intervention is an effective strategy for improving the QofL, self�esteem, empowerment of patients with HF [32].

[33] conducted a study to investigate the effects of the PRE�CEDE model on QofL, self�care �ehaviours and depression in elderly patients with HF. The patients were from the Geriatrics and Cardiology department of the researchers' hospital and those who met the admission criteria were randomly divided into two groups, the control group and the intervention group. All patients in the sample received conventional medical care, while patients in the intervention group received an additional 9 sessions of educational intervention �ased on the PRECEDE model [33]. Data were collected at the �eginning of the study and 3 months after the intervention, through 4 different ques�tionnaires: the MLHFQ ("Minnesota Living with Heart Failure Questionnaire") questionnaire for the investigation of PH, the PHQ � 9 questionnaire ("Person Health Questionnaire")/9 ques�tions) to explore personal health, the EHFScBS � 9 (“European Heart Failure Self � Care Behavior Scale” questionnaire / 9 ques�tions) to investigate self�care Behavior and the PRECEDE��ased factor assessment questionnaire predisposition, reinforcement and activation related to educational diagnosis and assessment. The results showed that there was a significant improvement

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in QofL, depression, self�care Behavior and predisposition, re�inforcement and activation factors regarding educational di�agnosis and assessment among patients �elonging to the in�tervention group, as opposed to the patient group, where no significant differences were o�served [33]. In addition, the QofL of patients with HF was significantly correlated with personal health (p value <0.001 / r=0.463) and with patients' self�care �ehaviors (p value <0.001 / r=0.584). Therefore, it is conclud�ed that promoting the education of patients with HF through nursing interventions, is effective in relieving the symptoms of depression, improving QofL and enhancing the self�care of pa�tients with HF [33].

The main purpose of the study �y [34] was to evaluate the effects of a cardiac reha�ilitation program on the QofL of pa�tients with HF. The sample consisted of 12 patients with HF who participated in a cardiac reha�ilitation program, which included exercise sessions, dietary guidance, and medication advice. The main outcome measure was the QofL, which was assessed with the SF � 36 questionnaire in the Portuguese version. Based on the results, there were significant improvements in physical function, functional capacity (p=0.003), physical role (p=0.03), and physical pain (p=0.02), as well as overall physical health. In contrast, no significant changes were o�served in other areas of QofL, as well as in overall mental health. Therefore, this cardiac reha�ilitation program �y providing exercise and nutritional, medication advice to patients with CHF only improves physical health, functional capacity, �ut not the other aspects of QofL in people with CHF [34].

The main purpose of the monocentric, mono��lind Rand�omized Controlled Study �y [35] was to examine the effect of a nursing counseling intervention on the improvement of QofL, the improvement of self�care and the hospital admission rate among patients with HF. The sample consisted of a total of 90 patients with HF, who were randomly divided into two differ�ent groups: the control group and the intervention group. In the control group, the usual care for HF was performed, i.e. a clinical examination was performed �y the doctor, appropri�ate medication and an appointment for follow�up, while in the intervention group, in addition to the usual care, patients re�ceived an educational �ooklet �ased on her theory. HF self�care and a daily monitoring chart, which was expected to record various measurements and characteristics, such as Blood Pres�sure, Pulse, Patient Weight, Swelling, and Daily Medication [35]. In addition, the patients in the intervention group received a set of instructions for various factors that they should pay attention to in their daily lives in the form of magnets. Outcome meas�ures, such as QofL and patient self�care, were collected �oth at the start of the intervention and 3 months and 6 months later. Based on the results, a statistically significant difference was o��served �etween the control group and the intervention group in terms of QofL scores (p <0.001) and self�care (p <0.001), at �oth 3 and 6 months. In addition, while the intervention group recorded fewer re�admissions to the hospital over a period of 3 months (p <0.05), no significant differences were o�served over a period of 6 months (p = 0.05) �etween the two groups. Therefore, nursing intervention for counseling and self�care in�structions seems to significantly improve the care and self�care of patients with HF, while, on the contrary, does not lead to a significant reduction in re�admission of patients to the hospital in 6 months [35].

[36] conducted a study to descri�e the conceptual frame�work, elements, and outcomes of a nursing intervention for

care goals in terms of applica�ility, acceptance, and �enefits in patients with HF, �oth in terms of patients themselves as well as health professionals. For this purpose, a sample of 41 patients with HF, average age 58.2 years and a sample of 9 health care providers specializing in HF was used. According to the results, the �enefits of the patients from this nursing intervention in�cluded the enhanced communication with the health profes�sional and his family mem�ers, increased confidence in con�ducting an honest and meaningful discussion with the health care provider and the constant renewal and upgrading his knowledge of HF [36]. At the same time, the �enefits of health professionals from this intervention were the facilitation of the discussion with the patient and the learning of new informa�tion a�out the goals and values of the patient. Therefore, goal�setting intervention provides a way to align patient's goals and values with advanced HF treatment options, with the ultimate goal of improving QofL and reducing patient care costs [36].

[37] conducted a multicenter, open, Controlled Rand�omized Study to evaluate the effectiveness of a comprehensive 4�month Telereha�ilitation Home � Based Program (Terea� � HBP) in patients with HF and COPD, at the same time. The sam�ple consisted of 112 patients, who were randomly divided into two groups. One group (54 people) was the control group, while the second group was the intervention group and received the Telerea� � HBP intervention, which included remote monitoring of cardio respiratory parameters, weekly telephone calls from nurses, from which they received information on the symptoms and condition of the disease, �ut also advice on diet, medication and lifestyle of patients. Outcome measures evaluated were ex�ercise endurance through the 6�min walk test (6MWT), QofL through the CAT (COPD Assessment Test) and MLHFQ (Minne�sota Living with Heart Failure Questionnaire ”), physical activity / a�ility through the PASE (“ Physical Activity Profile ”) tool, dys�pnoea through the MRC (“ Medical Research Council ”), disa�il�ity through the Barthel tool, and chronological incidents such as death and hospitalization of patients [37]. All these measures were evaluated at the �eginning of the study, after 4 months, and after 6 months, i.e. 2 months after the intervention was completed. Based on the results, after a period of 4 months, the patients in the intervention group were a�le to walk more than initially, while in the control group, no significant improvement in gait was o�served. Patients' QofL (p value=0 in the CAT tool, p value=0.0007 in the MLHFQ tool), as well as dyspnoea (p val�ue=0.05), disa�ility (p value=0.0006) and physical activity / a�il�ity (p value=0.0015), improved significantly, only in the group receiving the nursing intervention, while the average time for hospitalization or death was longer in the case of the interven�tion group (113.4 days vs. 104 , 7 in the control group). Overall, the 4�month Telerea� � HBP nursing intervention is an effective and feasi�le program for patients with CHF and COPD [37].

The aim of the Ng & Wong Controlled Randomized Study [38] was to examine the effect of a Home�Based Palliative Heart Failure (HPHF) program on HF, on functional status / a�ility / activity , in the �urden of symptoms, in patient satisfaction and in the �urden of caregivers �etween patients with end�stage HF. For this purpose, a total of 84 patients with end�stage HF were collected from 3 different hospitals and these patients were di�vided into two su�groups: the control group and the interven�tion group. In the control group, participants received counsel�ling palliative care and routine planning that includes patients' duties and care needs after discharge from the hospital. In the intervention group, patients with HF received the care and ad�vice received �y the control group and, in addition, received a

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structured schedule of regular home visits or telephone calls from nurses, lasting a total of 12 months [38]. The collection of the necessary data took place at the �eginning, 4 weeks, 12 weeks and one year after the start of the intervention. Based on the results, there was a statistically significant difference in the effects �etween the two groups, with the intervention group showing a significant improvement in QofL from the control group (p=0.016), while, at the same time, there was a signifi�cant effect of interaction �etween group and time (p=0.032). In contrast, there were no significant differences in effects �e�tween the two groups in terms of symptoms and functional sta�tus / a�ility / activity over a 12�week period. Finally, the inter�vention group showed significantly higher levels of satisfaction (p=0.001) and significantly lower caregiver workload (p=0.024) than the control group over a total period of 3 months. Overall, the HPHF program is particularly effective in improving the IQ of patients with end�stage HF, increasing patient satisfaction with care, and caring for carers [38].

[39] conducted a Non�Randomized Controlled Study to com�pare the effects of a training program, self�management in QofL among patients with chronic HF. The total num�er of partici�pants was 111 patients with chronic HF, who were divided into 3 su�groups: the control group (38 participants), the multi�media group (37 participants) and the multivariate group (36 participants). According to the results, statistically significant differences were o�served �etween the groups of multimedia and multiple methods in terms of QofL, after the interven�tion, compared to the control group (p <0.001 and p = 0.002, respectively) [39]. Statistically significant differences were also o�served �etween the two groups of interventions in terms of knowledge dimension and self�efficacy (p=0.047). , the educa�tional program proposed in this research seems to significantly improve the QofL of patients with KA and especially the multi�method approach seems to �e more effective than the multi�media method [39].

Discussion

From the present SR at a first glance it seems clear in terms of extracting positive results for the effectiveness of remote man�agement and the Non�Pharmacological approach of patients with HF. Most studies have well�esta�lished remote approach practices that do not differ much from each other. In particular, after the patient leaves the hospital, his complete history is en�riched with his updated contact details, the availa�le means of communication, to which he has full and daily or weekly access and receives the necessary printed or electronic material, with which he will to start his outpatient education and consequent�ly his outpatient nursing, counselling intervention. Despite their relative methodological homogeneity and the use of remark�a�le and weighted assessment tools for measuring Health�Re�lated QofL, knowledge of the �ackground of HF as a chronic dis�ease, self�management, self�preservation, self�care of patients with HF, it is worth mentioning that through the studies, which were reviewed, homogeneous socio�demographic data are not presented. Therefore, even when they were listed, they were not recorded in order to ensure the homogeneity, usa�ility and compara�ility of the listed qualitative characteristics of the studies. Most researchers emphasize that in order to success�fully complete the intervention, either through home visits or telephone sessions, it is very important to mo�ilize the patient in advance and inform him a�out the parameters of the disease he is facing. The relevant education must take place in the pres�

ence of his family and it is equally legitimate for them to �e informed with a�solute clarity a�out their special role in edu�cating, empowering, strengthening and mo�ilizing the patient.

None of the studies reviewed regarding the evaluation of the effectiveness of outpatient and non�pharmacological man�agement of the patient with HF reported moderate or negative results. On the contrary, all studies underline the a�solute im�portance of these interventions in the mo�ilization, function�ality, autonomy, self�preservation and spiritual euphoria of the patient. It follows, therefore, from the a�ove interventions:

�In the organized and coordinated context in which they are carried out

�In the advanced professional know�how, specialization, ex�perience of the specialized nurses, who undertake the imple�mentation of this project and

�In the successful cooperation of the whole interdisciplinary team, they are applied with a�solute success, causing only posi�tive results in the management of HF disease �y the patient and his close family environment, his caregivers.

However, the results of the studies differ in the magnitude of the patient's functionality or autonomy during or at the formal end of the outpatient management program. In addition, few of the studies reviewed are a�le to provide long�term results, as in most cases follow�up is not prospective: Of the studies reviewed, only the pu�lication of [27] showed positive results (state of health and self�preservation, self�management, self�efficacy, QofL, memory, self�confidence, reduction of depres�sion and enhanced knowledge a�out HF), 9 months later the completion of the nursing counseling management program and after the final termination of the patient�nurse contact.

An issue, which is underlined �y the studies that fall under this SR, is the necessary training and specialization that nurses must have, as health professionals, who undertake under medi�cal guidance to implement a management program, counseling patients with HF. In particular, as pointed out �y many studies, the know�how and academic �ackground of nurses must �e on par with the increased demands of an advanced remote coun�seling, mentoring support program. Targeted and specialized �asic, �ut also continuing education and training of nurses in the direction of this goal is a necessary condition.

Non�pharmacological management programs with coun�seling nursing intervention for patients with HF, focus on en�couraging the adoption of self�care �ehaviors �y the patient. As found �y the SR, they are usually educational in nature and are intended to help the patient understand the importance of compliance with medication, diet and other restrictions, en�hancing risk modification and lifestyle changes, and the value of exercise. in their daily life and in addition in their a�ility to rec�ognize the symptoms of worsening of the disease and to seek timely health care.

The interventions are made as shown �y the literature co�ordinated and individualized �y an interdisciplinary team of experts. Particular emphasis is given to the majority of HF man�agement programs �y a medical and nursing team. In many chronic HF disease management programs, the health care pro�fessional acts as a link �etween the HF patient and an interdis�ciplinary team or coordinates the team.

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Conclusions

It follows from the present conducted SR that with the imple�mentation of non�pharmacological management programs for patients with HF, programs, which are led �y nurses, are associ�ated with positive results in improving the self�management of the syndrome, self�maintenance, self�care, autonomy, empow�erment , �ut there are no equally, the same positive results, no statistically significant improvement was found in the health�related QofL of patients with HF. While there is an improvement in physical, physical functional capacity�dimension, as well as in mental�cognitive function, there is no corresponding improve�ment in the mental dimension of QofL, in the overall score of QofL and especially in the female population�sample of studies included in SR. There is complexity, diversity of these programs, �oth to determine the type of intervention �y counseling / edu�cational nursing, and the time, duration of the intervention, the intensity, the content of the management programs, as well as the duration of the follow up, �ut also in the esta�lishment of the group of health professionals, a fact for which the scientific community is una�le to accurately identify the characteristics of an effective program, in order to reduce the effects of the syndrome and improve the QofL of patients.

This demonstrates the need for further research, additional studies are needed, which will �egin with the key stratification of patients' risk at the patient's exit, on his or her transition from hospital to home. The collection of clinical and la�oratory data, together with a well�completed information note from the treating physician and with consulting nursing intervention, as well as with a holistic interdisciplinary approach, the phase of transition from hospital to home, which is the most vulnera�le period for the patient with HF, with an increased risk of death, especially in the first weeks after discharge. Further studies are needed to evaluate the results of the Non�Pharmacological Management of patients with HF in health related to time, du�ration of follow�up, esta�lishment of the interdisciplinary team, intensity and content of management programs to document the of these programs.

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the evaluation of the impact of nursing counselling

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