Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relat... more Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relatives with heart failure (HF). Nevertheless, caregivers can be subject to negative outcomes and sacrifice of personal needs due to their challenging caregiving role, which increases the demand for social support. Previous studies did not provide a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with HF. Methods: A convergent mixed-methods approach was used. In total, 158 patients with heart failure and their informal caregivers completed validated scales to measure their perceived social support, mutuality, anxiety, depression, and quality of life (physical and mental dimensions). Semi-structured interviews were conducted with 50 caregivers. Multiple linear regression analysis was conducted to identify the predictors of perceived social support, and content analysis was performed on qualitative data. The results were merged using joint displays. Results: Caregivers had a mean age of 57 (14.4 SD) and gave their care to the patients for an average hours per week of 30.38 (28.28 SD). Patients with HF had a mean age of 73.74 (13.46 SD) mostly (48.7 %) in NYHA class II. Quantitative results showed that caregivers perceived better social support when they had a better mental quality of life and higher levels of mutuality. Likewise, when patients’ levels of mutuality were lower, caregivers felt less socially supported. Qualitative findings support that perceived social support was influenced by the caregiver’s mutuality, the patient’s involvement in self-care and the caregiver’ emotional state. Integration of quantitative and qualitative data confirmed that caregivers’ mutuality and emotional state influenced caregivers’ social support. Conclusions: Mental health status can affect caregivers’ ability to perceive social support. There is a need to develop and evaluate individual and community-based strategies to promote caregivers’ mental health for increasing their perceived sense of social support and community belonging. More dyadic strategies should be developed to improve caregiver-caregiver mutuality to increase the sense of support in the heart failure caregiving process.
What is already known about the topic? Non-adherence resulting in increased hospitalisations is c... more What is already known about the topic? Non-adherence resulting in increased hospitalisations is common in patients with HF. Telemonitoring is one of the recently developed as part of chronic care management systems in patients with HF; however randomised controlled trials are lacking to proof its (cost-) effectiveness. The majority of the telemonitoring systems focuses on vital signs such as blood pressure, rate control and weight.
Recent increases in heart failure tend to overload the healthcare system. Consequently, there is ... more Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. Methods and results A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32-93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan-Meier P ¼ 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35-1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan-Meier P ¼ 0.641, HR 0.89, 95% CI 0.69-1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann-Whitney P , 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann-Whitney P ¼ 0.34, Cox regression analysis P ¼ 0.82). Conclusion No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed. Trial registration: NCT00502255.
European Journal of Cardiovascular Nursing, Apr 29, 2013
Background: The education of patients with heart failure (HF) is an essential part of disease man... more Background: The education of patients with heart failure (HF) is an essential part of disease management. The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active. Methods: Three hundred and eighty-two patients with HF (age 71±SD 11.2 years) were randomly assigned to either a telemonitoring or a usual care group. Patients received four postal questionnaires to assess their levels of self-reported knowledge, self-care, self-efficacy and adherence. Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up. Corrections for baseline were performed if needed. Results: Baseline differences between groups were found for self-care (p=0.001) and self-efficacy (p=0.024). Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale (p<0.001). Their selfcare abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care (p<0.001). Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year. For patients in the intervention group adherence improved for daily weighing (p<0.001) during the whole follow-up and for fluid intake (p=0.019) after 3 months and after 12 months (p=0.086). Adherence for activity recommendations improved (p=0.023) after 3 months and importance of medication adherence increased after 6 (p=0.012) and 12 months (p=0.037). No effects were found regarding appointments, diet, smoking and use of alcohol. Conclusions: Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy.
Telemonitoring positively influences some aspects of quality of life. Furthermore it reduces pati... more Telemonitoring positively influences some aspects of quality of life. Furthermore it reduces patients' depression and anxiety scores on the short run. The current article presents the results of a one year follow-up study regarding the impact of a first generation telemonitoring system on depression and Quality of Life scores in patients with heart failure.
Journal of the American College of Cardiology, Apr 1, 2011
Background: Recent increasing prevalence of heart failure (HF) patients leads to an increasing bu... more Background: Recent increasing prevalence of heart failure (HF) patients leads to an increasing burden to the health care system. Consequently, there is a need for innovative strategies to reduce HF hospitalizations. Methods: We performed a multicentre randomized controlled trial to test the hypothesis that telemonitoring in patients with HF, by means of the Health Buddy® system (HB), will reduce HF hospitalizations and number of contacts with caregivers as compared to care as usual (CAU) during 1
Background Informal caregivers contribute substantially to the self-care of people with heart fai... more Background Informal caregivers contribute substantially to the self-care of people with heart failure (HF) by helping with concrete and interpersonal tasks. Time perception and management are essential issues among caregivers. However, investigators have not explored this topic in caregivers of people with HF. Objectives The aim of this study was to describe the perceptions and challenges of the time management experience among caregivers who support the self-care efforts of their relatives with HF. Methods Adult informal caregivers of patients with HF, taking care of the patient for at least 3 months and without cognitive limitations, were recruited from Spain, Italy, and the Netherlands. Data were collected using semistructured interviews. Maryring's qualitative content analysis strategy with both a deductive and an inductive approach was used for analysis. Results We enrolled 50 participants (20 Italians, 19 Spanish, and 11 Dutch). Caregivers had a mean (SD) age of 62.8 (12.8...
Background Functional status and health-related quality of life (HRQoL) are important in patients... more Background Functional status and health-related quality of life (HRQoL) are important in patients with
Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relat... more Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relatives with heart failure (HF). Nevertheless, caregivers can be subject to negative outcomes and sacrifice of personal needs due to their challenging caregiving role, which increases the demand for social support. Previous studies did not provide a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with HF. Methods: A convergent mixed-methods approach was used. In total, 158 patients with heart failure and their informal caregivers completed validated scales to measure their perceived social support, mutuality, anxiety, depression, and quality of life (physical and mental dimensions). Semi-structured interviews were conducted with 50 caregivers. Multiple linear regression analysis was conducted to identify the predictors of perceived social support, and content analysis was performed on qualitative data. The results were merge...
Aims Heart failure (HF) is a common cause of mortality and (re)hospitalizations. The NWE-Chance p... more Aims Heart failure (HF) is a common cause of mortality and (re)hospitalizations. The NWE-Chance project explored the feasibility of providing hospitalizations at home (HH) supported by a newly developed digital health platform. The aim of this study was to explore the perceived usability by healthcare professionals (HCPs) of a digital platform in addition to HH for HF patients. Methods and results A prospective, international, multicentre, single-arm interventional study was conducted. Sixty-three patients and 22 HCPs participated. The HH consisted of daily home visits by the nurse and use of the platform, consisting of a portable blood pressure device, weight scale, pulse oximeter, a wearable chest patch to measure vital signs (heart rate, respiratory rate, activity level, and posture), and an eCoach for the patient. Primary outcome was usability of the platform measured by the System Usability Scale halfway and at the end of the study. Overall usability was rated as sufficient (me...
People interested in the research are advised to contact the author for the final version of the ... more People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement:
AimsTo explore caregivers' needs and problems in three European countries and associate the c... more AimsTo explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics.DesignA qualitative focused mixed methods design was used.MethodsIn total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven‐phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed.ResultsThree clusters of caregivers were identified: spouses, adult children and non‐family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health.ConclusionsInformal caregiving emerged as a complex process influenced by various s...
Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically ... more Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%...
Heart failure is a complex disease with poor outcome. This complexity may prevent care providers ... more Heart failure is a complex disease with poor outcome. This complexity may prevent care providers from covering all aspects of care. This could not only be relevant for individual patient care, but also for care organisation. Disease management programmes applying a multidisciplinary approach are recommended to improve heart failure care. However, there is a scarcity of research considering how disease management programme perform, in what form they should be offered, and what care and support patients and care providers would benefit most. Therefore, the Improving kNowledge Transfer to Efficaciously Raise the level of Contemporary Treatment in Heart Failure (INTERACTin-HF) study aims to explore the current processes of heart failure care and to identify factors that may facilitate and factors that may hamper heart failure care and guideline adherence. Within a cross-sectional mixed method design in three regions of the NorthWest part of Europe, patients (n ¼ 88) and their care providers (n ¼ 59) were interviewed. Prior to the in-depth interviews, patients were asked to complete three questionnaires: The Dutch Heart Failure Knowledge scale, The European Heart Failure Self-care Behaviour Scale and The global health status and social economic status. In parallel, retrospective data based on records from these (n ¼ 88) and additional patients (n ¼ 82) are reviewed. All interviews were audiotaped and transcribed verbatim for analysis.
Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relat... more Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relatives with heart failure (HF). Nevertheless, caregivers can be subject to negative outcomes and sacrifice of personal needs due to their challenging caregiving role, which increases the demand for social support. Previous studies did not provide a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with HF. Methods: A convergent mixed-methods approach was used. In total, 158 patients with heart failure and their informal caregivers completed validated scales to measure their perceived social support, mutuality, anxiety, depression, and quality of life (physical and mental dimensions). Semi-structured interviews were conducted with 50 caregivers. Multiple linear regression analysis was conducted to identify the predictors of perceived social support, and content analysis was performed on qualitative data. The results were merged using joint displays. Results: Caregivers had a mean age of 57 (14.4 SD) and gave their care to the patients for an average hours per week of 30.38 (28.28 SD). Patients with HF had a mean age of 73.74 (13.46 SD) mostly (48.7 %) in NYHA class II. Quantitative results showed that caregivers perceived better social support when they had a better mental quality of life and higher levels of mutuality. Likewise, when patients’ levels of mutuality were lower, caregivers felt less socially supported. Qualitative findings support that perceived social support was influenced by the caregiver’s mutuality, the patient’s involvement in self-care and the caregiver’ emotional state. Integration of quantitative and qualitative data confirmed that caregivers’ mutuality and emotional state influenced caregivers’ social support. Conclusions: Mental health status can affect caregivers’ ability to perceive social support. There is a need to develop and evaluate individual and community-based strategies to promote caregivers’ mental health for increasing their perceived sense of social support and community belonging. More dyadic strategies should be developed to improve caregiver-caregiver mutuality to increase the sense of support in the heart failure caregiving process.
What is already known about the topic? Non-adherence resulting in increased hospitalisations is c... more What is already known about the topic? Non-adherence resulting in increased hospitalisations is common in patients with HF. Telemonitoring is one of the recently developed as part of chronic care management systems in patients with HF; however randomised controlled trials are lacking to proof its (cost-) effectiveness. The majority of the telemonitoring systems focuses on vital signs such as blood pressure, rate control and weight.
Recent increases in heart failure tend to overload the healthcare system. Consequently, there is ... more Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. Methods and results A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32-93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan-Meier P ¼ 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35-1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan-Meier P ¼ 0.641, HR 0.89, 95% CI 0.69-1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann-Whitney P , 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann-Whitney P ¼ 0.34, Cox regression analysis P ¼ 0.82). Conclusion No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed. Trial registration: NCT00502255.
European Journal of Cardiovascular Nursing, Apr 29, 2013
Background: The education of patients with heart failure (HF) is an essential part of disease man... more Background: The education of patients with heart failure (HF) is an essential part of disease management. The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active. Methods: Three hundred and eighty-two patients with HF (age 71±SD 11.2 years) were randomly assigned to either a telemonitoring or a usual care group. Patients received four postal questionnaires to assess their levels of self-reported knowledge, self-care, self-efficacy and adherence. Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up. Corrections for baseline were performed if needed. Results: Baseline differences between groups were found for self-care (p=0.001) and self-efficacy (p=0.024). Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale (p<0.001). Their selfcare abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care (p<0.001). Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year. For patients in the intervention group adherence improved for daily weighing (p<0.001) during the whole follow-up and for fluid intake (p=0.019) after 3 months and after 12 months (p=0.086). Adherence for activity recommendations improved (p=0.023) after 3 months and importance of medication adherence increased after 6 (p=0.012) and 12 months (p=0.037). No effects were found regarding appointments, diet, smoking and use of alcohol. Conclusions: Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy.
Telemonitoring positively influences some aspects of quality of life. Furthermore it reduces pati... more Telemonitoring positively influences some aspects of quality of life. Furthermore it reduces patients' depression and anxiety scores on the short run. The current article presents the results of a one year follow-up study regarding the impact of a first generation telemonitoring system on depression and Quality of Life scores in patients with heart failure.
Journal of the American College of Cardiology, Apr 1, 2011
Background: Recent increasing prevalence of heart failure (HF) patients leads to an increasing bu... more Background: Recent increasing prevalence of heart failure (HF) patients leads to an increasing burden to the health care system. Consequently, there is a need for innovative strategies to reduce HF hospitalizations. Methods: We performed a multicentre randomized controlled trial to test the hypothesis that telemonitoring in patients with HF, by means of the Health Buddy® system (HB), will reduce HF hospitalizations and number of contacts with caregivers as compared to care as usual (CAU) during 1
Background Informal caregivers contribute substantially to the self-care of people with heart fai... more Background Informal caregivers contribute substantially to the self-care of people with heart failure (HF) by helping with concrete and interpersonal tasks. Time perception and management are essential issues among caregivers. However, investigators have not explored this topic in caregivers of people with HF. Objectives The aim of this study was to describe the perceptions and challenges of the time management experience among caregivers who support the self-care efforts of their relatives with HF. Methods Adult informal caregivers of patients with HF, taking care of the patient for at least 3 months and without cognitive limitations, were recruited from Spain, Italy, and the Netherlands. Data were collected using semistructured interviews. Maryring's qualitative content analysis strategy with both a deductive and an inductive approach was used for analysis. Results We enrolled 50 participants (20 Italians, 19 Spanish, and 11 Dutch). Caregivers had a mean (SD) age of 62.8 (12.8...
Background Functional status and health-related quality of life (HRQoL) are important in patients... more Background Functional status and health-related quality of life (HRQoL) are important in patients with
Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relat... more Introduction: Caregivers play an instrumental role in ensuring adequate self-care for their relatives with heart failure (HF). Nevertheless, caregivers can be subject to negative outcomes and sacrifice of personal needs due to their challenging caregiving role, which increases the demand for social support. Previous studies did not provide a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with HF. Methods: A convergent mixed-methods approach was used. In total, 158 patients with heart failure and their informal caregivers completed validated scales to measure their perceived social support, mutuality, anxiety, depression, and quality of life (physical and mental dimensions). Semi-structured interviews were conducted with 50 caregivers. Multiple linear regression analysis was conducted to identify the predictors of perceived social support, and content analysis was performed on qualitative data. The results were merge...
Aims Heart failure (HF) is a common cause of mortality and (re)hospitalizations. The NWE-Chance p... more Aims Heart failure (HF) is a common cause of mortality and (re)hospitalizations. The NWE-Chance project explored the feasibility of providing hospitalizations at home (HH) supported by a newly developed digital health platform. The aim of this study was to explore the perceived usability by healthcare professionals (HCPs) of a digital platform in addition to HH for HF patients. Methods and results A prospective, international, multicentre, single-arm interventional study was conducted. Sixty-three patients and 22 HCPs participated. The HH consisted of daily home visits by the nurse and use of the platform, consisting of a portable blood pressure device, weight scale, pulse oximeter, a wearable chest patch to measure vital signs (heart rate, respiratory rate, activity level, and posture), and an eCoach for the patient. Primary outcome was usability of the platform measured by the System Usability Scale halfway and at the end of the study. Overall usability was rated as sufficient (me...
People interested in the research are advised to contact the author for the final version of the ... more People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement:
AimsTo explore caregivers' needs and problems in three European countries and associate the c... more AimsTo explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics.DesignA qualitative focused mixed methods design was used.MethodsIn total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven‐phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed.ResultsThree clusters of caregivers were identified: spouses, adult children and non‐family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health.ConclusionsInformal caregiving emerged as a complex process influenced by various s...
Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically ... more Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%...
Heart failure is a complex disease with poor outcome. This complexity may prevent care providers ... more Heart failure is a complex disease with poor outcome. This complexity may prevent care providers from covering all aspects of care. This could not only be relevant for individual patient care, but also for care organisation. Disease management programmes applying a multidisciplinary approach are recommended to improve heart failure care. However, there is a scarcity of research considering how disease management programme perform, in what form they should be offered, and what care and support patients and care providers would benefit most. Therefore, the Improving kNowledge Transfer to Efficaciously Raise the level of Contemporary Treatment in Heart Failure (INTERACTin-HF) study aims to explore the current processes of heart failure care and to identify factors that may facilitate and factors that may hamper heart failure care and guideline adherence. Within a cross-sectional mixed method design in three regions of the NorthWest part of Europe, patients (n ¼ 88) and their care providers (n ¼ 59) were interviewed. Prior to the in-depth interviews, patients were asked to complete three questionnaires: The Dutch Heart Failure Knowledge scale, The European Heart Failure Self-care Behaviour Scale and The global health status and social economic status. In parallel, retrospective data based on records from these (n ¼ 88) and additional patients (n ¼ 82) are reviewed. All interviews were audiotaped and transcribed verbatim for analysis.
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