Peer Support Model On Quality Of Life And Cardiac Function Of Patients With Chronic Heart Failure

AimsThe aim of this study was to explore the factors of quality of life of patients with chronic heart failure using a case-control study design.Based on the results,the peer support model for patients with chronic heart failure made before would be revised.The other aim of this study was to evaluate the effect of peer support model on quality of life,cardiac function(six minutes walking test results),emergency-visit,readmission,level of knowledge related to heart failure of patients with chronic heart failure.Methods1.The case-control study on factors of quality of life of patients with chronic heart failureA case-control study was performed in the vasculocardiology department for patients with chronic heart failure in Zhongda Hospital,Southeast University.Patients with high quality of life(≤30)were in the control group,while patients with low quality of life(>30)were in the case group.There were 120 cases in each individual group.Univariate analysis and multivariate logistic regression were used to analyze the effectiveness of various factors related to quality of life of patients with chronic heart failure.The quantitative data was compared with independent sample t-test,and the grade data was conducted by chi-square test.The peer support mode was revised,according to the result of the case-control study.2.Peer support model on quality of life and cardiac function of patients with chronic heart failureCommunities were selected and randomized into experimental group and control group,which are within the jurisdiction of Mofan West Road and Changjiang Community Health Center.The sample contained 170 patients with chronic heart failure who lived in the research communities and met the inclusion criteria,and were divided into two subgroups.The control group(n=85)only received self-management education for 12 months,while the the experiment group(n=85)were given self-management education and peer support.Data was collected at 6 months and 12 months of intervention.Quality of life,cardiac function(six minutes walking test results),emergency-visit,readmission,level of knowledge related to heart failure of the patients were compared between the two groups by repeated measures data of ANOVA.Results1.The case control study(1)Univariate analysis indicated that:the differences were statistically significant between the case group and the control group,in dyspnea,hospitalization for heart failure in the last year,level of cardiac function,self-care ability,social support,anxiety,edema,ways of medical payments,whether with stents,complications(P<0.05).But there were no statistically significant difference between the two groups in education,LVEF,depression,family monthly income and duration of disease(P>0.05).(2)Logistic regression analysis showed that:dyspnea(OR=2.300,95%CI=1.287-4.109),hospitalization for heart failure in the last year(OR=1.271,95%CI:1.027-1.573),level of cardiac function(OR=1.475,95%CI:1.031-2.110),self-care ability(OR=0.964,95%CI:0.941-0.989),anxiety(OR=2.143,95%CI:1.300-3.535),complications(OR=1.469,95%CI:1.179-1.831)were discovered as the main factors of quality of life of patients with heart failure.(P<0.05).2.The application studyA total of 163 subjects completed all data collection,81 cases of the experiment group and 82 cases of the control group.No significant differences were found between two subgroups at baseline(P>0.05).(1)Quality of life:At 6 months,the emotional domain score,the other domain score and quality of life total score of the experiment group were significantly lower than that of the control group(P<0.05),but there were no differences in body function domain(P>0.05).At 12 months,there domains scores and total score of quality of life of the experiment group were significantly lower than that of the control group(P<0.05).(2)Cardiac function(six minutes walking test results,6MWT):At 6 months,there were no differences in 6MW by intra-group comparison(P>0.05).At 12 months,the score of the experiment group(361.07±58.74)was significantly higher than that of the control group(343.91±57.71)(P<0.05).(3)Emergency-visit and readmission:At 6 months,there were no differences in emergency-visit and readmission for heart failure between the experiment group(25.93%,29.63%)and the control group(31.71%,32.93%)(P>0.05).At 12 months,the ratio of emergency-visit and readmission of the experiment group(16.05%,13.58%)werebothsignificantlylowerthanthoseofthecontrol group(30.49%,29.27%)(?~2=4.752,P=0.029;?~2=5.965,P=0.015).(4)Level of knowledge related to heart failure:At 6 months,the score of knowledge related to heart failure of the experiment group was significantly higher than that of the control group(P<0.05).At 12 months,the score of the experimental group(66.23±9.74)was significantly higher than those in the control group(60.96±11.71)(P<0.05).Conclusions1.Dyspnea,hospitalization for heart failure in the last year,level of cardiac function,anxiety,and complications were independent risk factors for quality of life of heart failure patients,and self-care ability was a independent protective factor.2.Compared with self-management education of the control group,peer support model can help patients with chronic heart failure to improve quality of life and cardiac function(six minutes walking test results),reduce the rate of emergency-visit and readmission,increase the level of knowledge related to heart failure.3.In this study,the effect of peer support model on the long-term(12 months)intervention was s significantly better than that on short-term(6 months).At 6 months,the results of body function domain of quality of life,cardiac function(six minutes walking test results),emergency-visit and readmission,the level of knowledge related to heart failure were not obvious.Because of the small research sample,the short-term effect of peer support is not obvious.It is worthy of further research to expand the sample size to demonstrated its effect.