The impact of symptom management programs in outpatient congestive heart failure clinics on self-care: The participant's perspective

Purpose. The purpose of this naturalistic study was to: (a) understand how attending an outpatient (OP) congestive heart failure (CHF) clinic allowed participants to self-manage symptoms of CHF at home, and (b) identify ways to enhance or refine treatments participants receive in an OP CHF clinic.; Sample. Eleven females and four males enrolled into the same OP CHF clinic within the past six months participated in this study. The average age was 70 years. The majority of participants were white, well educated, averaged 70 years of age, had New York Heart Association class III symptoms, and at least one comorbid condition.; Method. After obtaining written consent, participants completed a standardized demographic data form and then completed audiotaped, in-person, semi-structured interviews lasting one-two hours. Follow-up audiotaped telephone interviews were conducted two-three weeks later to clarify or elaborate on concepts. Interviews were transcribed and entered into Ethnograph RTM to facilitate line-by-line numbering. Qualitative data were analyzed using content analysis and constant comparison.; Findings. Quantitative data were analyzed using SPSS RTM and NCSSRTM statistical software packages. Chi-square analysis revealed statistically fewer (p = .04) hospital admissions after enrollment in the OP CHF clinic compared to pre-enrollment. A statistical significance was also present in the number of subjects self-reporting CHF symptoms pre versus post enrollment in the OP CHF clinic: fatigue (p = .032), irritability (p = .025), nocturnal dyspnea (p = .0025), dizziness, hallucinations, and somnolence (p = .046), poor appetite (p = .028), poor stamina (p = .032), shortness of breath at rest (p = .00019), and swelling (p = .0053).; Four global categories from data exploring participant decisions regarding enrollment and attendance in the OP CHF clinic: referral patterns, influences on decision to enroll, influences on attendance decisions, and recommendations from participants. All participants recommended anyone diagnosed with CHF enroll in an OP CHF clinic, before symptoms occur, if possible.; Data analysis to describe participant's perceived benefits from attending the OP CHF clinic resulted in four global categories: seeing management is possible, learning to manage symptoms, assistance with management, and taking control. Participants had significantly fewer symptoms, less hospital admissions, and improved outcomes through enrollment. The results of this study provide beginning knowledge of how enrollment in an OP CHF clinic assists with self-management activities.