Effect Of Espcs Intervention On Quality Of Life In Nyha Class Ⅲ Chronic Heart Failure Patients

Objective To investigate the level of self-perceived burden,cardiac function,and daily living ability,and the quality of life in the NYHA class Ⅲ chronic heart failure patients,to analyze the influencing factors of the quality of life,and to explore the effect of “Explain-Simulate-Practice-Communication-Support(ESPCS)” interventions on quality of life in the NYHA class Ⅲ chronic heart failure patients.It might provide the basic references for rehabilitation of the NYHA class Ⅲ chronic heart failure patients.Methods(1)By using the general data questionnaire,self-perceived burden scale,cardiac function indexes [6 minute walking test(6MWT),left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NTproBNP)],modified barthel index scale and minnesota living heart failure questionnaire as survey tools,297 NYHA class Ⅲ chronic heart failure patients were investigated to acquaint their level of self-perceived burden,cardiac function and daily living ability,and their quality of life,then analyzed the factors that affect the quality of life.(2)We selected 88 NYHA class Ⅲ chronic heart failure patients from cardiovascular department at a top-level hospital in Hengyang City as study subjects.Randomized numbers were used to randomly divide the patients into the intervention group(44 persons)and the control group(44 persons).According to the physical and psychological characteristics of the NYHA classⅢ chronic heart failure patients,worked out the ESPCS intervention program.The control group was treated with conventional anti-heart failure treatment and routine nursing;the intervention group was given ESPCS intervention on the basis of conventional anti-heart failure treatment and routine nursing.After 3months of intervention,We compared the differences in self-perceived burden levels,cardiac function,daily living ability,and quality of life between the two groups.The data were analyzed by using the Statistical Package for the Social Sciences(SPSS)18.0.The means,standard deviations and percentages were used as the statistical description;One-way analysis of variance,multiple stepwise regression analysis,pearson correlation analysis,two independent samples t test or approximate t test,paired t test,Chi square(c2)test,Wilcoxon rank sum test and other statistical methods were used for statistical analysis.Results(1)The score of self-perceived burden in the NYHA class Ⅲ chronic heart failure patients was(34.57±5.39);Cardiac function indexes of the NYHA class Ⅲ chronic heart failure patients were as follows :The distance of 6-minute walking test was(183.27 + 54.54)meters,LVEF was(45.41 ± 11.13)% and NT-proBNP was(2557.36±1368.35)ng/L;The score of modified barthel index scale in the NYHA class Ⅲ chronic heart failure patients was(67.22±15.80).(2)The score of minnesota living heart failure questionnaire in the NYHA class Ⅲ chronic heart failure patients was(77.40 ± 11.22)minutes.The scores in each dimension were as follows: physical field was(31.32±5.28),other fields was(27.37±4.85),and emotional field was(18.56±3.51).(3)The ways for medical payment,heart failure course,self-perceived burden,heart function,and daily living ability were the main factors affecting the quality of life in NYHA Class Ⅲ chronic heart failure patients.These five factors could explain 50.7% of the total variation of the equation.(4)Before intervening,there were no significant differences in the general data,the level of self-perceived burden,cardiac function index(6MWT,LVEF,NT-proBNP,and NYHA classification),daily living ability and quality of life between intervention group and control group(P>0.05).(5)Before intervening,the self-perceived burden scores of NYHA class Ⅲ chronic heart failure patients in the intervention group and the control group were higher than those after the intervention,the differences were statistically significant(P<0.05);after the intervention,the self-perceived burden score of the intervention group patients was significantly lower than the control group(P<0.05).(6)After intervening,changes of cardiac function in the NYHA class Ⅲ chronic heart failure patients were as follows: For two groups,the distance of6 MWT and the LVEF was higher than those before the intervention in two groups(P<0.05),and the intervention group was significantly higher than those in the control group(P<0.05);the level of NT-proBNP and NYHA classification was significantly lower than those before the intervention(P<0.05),and the intervention group was significantly lower than the control group(P < 0.05).(7)After intervening,the scores of modified barthel index scale in the intervention group and control group were higher than before the intervention(P<0.05),and the score of modified barthel index scale in the intervention group was significantly higher than those in the control group(P<0.05).(8)After intervening,the scores of quality of life in the intervention group and control group were lower than those before the intervention(P<0.05),and the score of quality of life in the intervention group was significantly lower than those of the control group(P<0.05).Conclusions(1)The main factors affecting the quality of life of NYHA class Ⅲ chronic heart failure patients were the ways for medical payment,heart failurecourse,self perceived burden level,cardiac function,and daily living ability.(2)ESPCS intervention can improve quality of life in NYHA class Ⅲ chronic heart failure patients by reducing the level of self-perceived burden,improving their cardiac function and their daily living activities.