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Objectives: To determine the effect of nurse-implemented transitional care (TC) on readmission and mortality rates in Chinese individuals with chronic heart failure (CHF) in Hong Kong., Design: Single-center randomized controlled trial of TC versus usual care (UC)., Setting: University-affiliated hospital in Hong Kong., Participants: Hospitalized Chinese individuals with CHF (N = 178; aged 78.6 ± 6.9, 45% male)., Measurements: The TC group received a predischarge visit, two home visits, and then regular telephone calls over 9 months to provide self-care education and support, optimized health surveillance, and facilitation in use of community services. Primary endpoints were event-free survival, all-cause hospital readmission, and mortality during the 9-month follow-up. Secondary endpoints were length of hospital stay, self-care, and health-related quality of life (HRQL). Data were analyzed using survival analysis and generalized estimating equations, following an intention-to-treat principle., Results: Survival analysis indicated no significant differences in event-free survival, hospital readmission, or mortality between the TC and UC groups, although the TC group had a lower hospital readmission rate at 6 weeks (8.1% vs 16.3%, P = .048) and lower mortality at 9 months (4.1% vs 13.8%, P = .03). The TC group also had a shorter hospital stay (P = .006) and significantly better self-care and HRQL. Because of attrition, sensitivity analyses were conducted to examine whether the intention-to-treat assumption affected the results. Per-protocol population analyses (hazard ratio (HR) = 0.40, 95% confidence interval (CI) = 0.17-0.93) and worst-case-scenario analysis (HR = 0.44, 95% CI = 0.25-0.77) suggested a lower mortality risk in the TC group., Conclusion: The translation of individual-centered nurse-implemented TC to the Chinese culture and healthcare context of Hong Kong appears beneficial., (© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.)

Background: Effective self-care is the cornerstone of the successful management of heart failure (HF). The European Heart Failure Self-care Behaviour Scale is a brief, reliable and valid scale to measure this important construct among patients with HF. Although the EHFScBS has been translated to different languages, no Chinese version is available. Indeed, previous findings investigating the psychometric properties of EHFScBS indicated ambiguity of the conceptual structure of this scale., Aim: The aim of this study was to translate the European Heart Failure Self-care Behaviour Scale (EHFScBS) into Chinese and to test its psychometric properties in the Chinese patients with HF., Methods: The EHFScBS (English Version) was translated to Chinese using Brislin's forward and backward translation method. Panel review was used to examine its semantic equivalence and content validity. The EHFScBS (Chinese Version) was then tested with a convenience sample of 143 Chinese HF patients who attended a specialist clinic from January to September 2007., Results: The content validity index (CVI) of the EHFScBS (Chinese version) was satisfactory (Item CVI=0.96; Scale CVI=0.89), with Cronbach's alpha 0.82. Convergent validity was supported by a moderate relationship, statistical significant with a measure for social support (r=-0.36, p<0.001). However, the findings did not support the hypothesised three-factor structure of the EHFScBS (Chinese Version). Instead, all items except one fit well a two-factor structure to measure help-seeking and regimen-complying behaviours., Conclusion: The adequate psychometric properties and clear conceptual structure of EHFScBS (Chinese Version) warrant its use in Chinese patients with HF., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Aim: This paper is a report of a study conducted to examine the effects of a relaxation training programme on the health-related quality of life of Chinese patients with chronic heart failure., Background: Despite the substantial evidence indicating the beneficial effects of relaxation therapy on the health-related quality of life of various cardiac populations, the value of this intervention in patients with chronic heart failure remains uncertain. Even less is known about its therapeutic effects in Chinese culture., Method: A total of 121 Chinese patients with chronic heart failure and over 60 years of age were recruited in 2002-2003 and randomly allocated to a relaxation training programme (n = 59) or an attention-control intervention (n = 62). The training included two relaxation training sessions, one skill revision workshop, twice daily relaxation self-practice and biweekly telephone follow-up. The World Health Organization Quality of Life questionnaire was completed at hospital discharge and at the 8th and 14th weeks after discharge., Results: Repeated measures analysis of covariance indicated that those who attended the relaxation training programme reported statistically significantly greater improvement in psychological (P = 0.007, eta(2) = 0.043) and social (P = 0.016, eta(2) = 0.035) health-related quality of life than those who received the attention-control intervention over the evaluative period. Comparing outcomes at timepoints showed that the statistically significant group differences in the improvement of psychological and social health-related quality of life occurred mainly during the first evaluative endpoints., Conclusion: Relaxation techniques are beneficial to the emotional and social health-related quality of life of Chinese patients with chronic heart failure. Combining this intervention with other treatment modalities may produce a more substantial improvement in their health-related quality of life.

Aim: This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure., Background: Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience., Data Sources: Eligible studies published in 1997-2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals., Review Methods: Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis., Findings: Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition., Conclusion: Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process.

Aims and Objectives: To evaluate the effectiveness and cost-effectiveness of a community nurse-supported hospital discharge programme in preventing hospital re-admissions, improving functional status and handicap of older patients with chronic heart failure., Design: Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re-admission at six months. Secondary outcomes were number of unplanned re-admissions, six-minute walking distance, London Handicap Scale and public health care and personal care costs., Results: At sixth months, the re-admission rates were not significantly different (46 vs. 57% in control subjects, p = 0.233, Chi-square test). But the median number of re-admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0.057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0.5 in control subjects, p = 0.002, Mann Whitney test), but there was no difference in six-minute walking distance. There was no significant group difference in median total public health care and personal care costs., Conclusion: Community nurse-supported post-discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re-admissions. The cost benefits to public health care were not significant., Relevance to Clinical Practice: Older chronic heart failure patients are likely to benefit from post-discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken.

Background: Previous studies demonstrated the effects of progressive muscle relaxation training (PMRT) on improvements in the health outcomes of cardiac patients. This study examined the effects of PMRT on the psychologic status and symptoms of older Chinese patients with heart failure., Methods: In a longitudinal, randomized, and controlled study, 59 patients were allocated to receive a PMRT program and 62 were provided with the attention placebo. The PMRT program included two PMRT sessions, one revision workshop, twice-daily PMRT home practices, and a biweekly telephone follow-up call. The attention placebo included a regular telephone call at a schedule similar to that made by the interventionist of the PMRT program with the intervention group. Main outcome measures, including psychologic distress, dyspnea, and fatigue, were taken at baseline, the 8th week, and the 14th week., Results: A medium effect on psychologic distress in favor of the PMRT program was detected. Patients practicing PMRT however only demonstrated a nonsignificant trend of greater improvement in symptom status., Conclusion: Progressive muscle relaxation training seems to be useful as an adjunctive nonpharmacologic treatment modality in the management of heart failure.

Purpose: The aim of this study was to develop and evaluate a community-based programme for heart failure patients, with emphasis on exercise and education., Method: In a before-and-after trial, subjects with heart failure underwent a 12-week group programme comprising of exercise, education and mutual support. Outcome measures included subjects' compliance and views of the programme, knowledge related to disease management, physical parameters (symptoms, exercise tolerance, muscle strength) and psychosocial well-being (using generic and disease-specific tools). A focus group was held and participants' feedback noted., Results: Overall patient compliance and satisfaction rate was high. Significant changes were observed in knowledge, physical performance and psychosocial parameters. Subjects' feedback following the programme was generally positive., Conclusions: This pilot study shows that a group programme for heart failure patients is feasible, acceptable and improved physical status and quality of life. It can be a useful model in the management of chronic disease in the community.

Aims: Disease management programmes (DMPs) have evolved as an innovative clinical practice system to enhance the discharge outcomes of older people with heart failure. Yet, clinical trials which have examined their effectiveness have reported inconsistent findings. This may be explained by variations in the design of DMPs. The aim is to identify the characteristics of DMPs which are crucial to reducing hospital readmission and/or mortality of older people with heart failure., Methods and Results: A systematic computerized search was conducted to identify randomized controlled trials of the last 10 years, which examined the effects of DMPs on hospital readmission and mortality of older people with heart failure. The identified DMPs were classified as effective and ineffective, according to statistically significant changes in discharge outcomes. Twenty-one trials were identified, 11 (52.4%) of which reported DMPs improving the discharge outcomes of older people with heart failure. The results indicate that an effective DMP should be multi-faceted and consists of an in-hospital phase of care, intensive patient education, self-care supportive strategy, optimization of medical regimen, and ongoing surveillance and management of clinical deterioration. Cardiac nurse and cardiologist should be actively involved and a flexible approach should be adopted to deliver the follow-up care., Conclusion: This study defines precisely the characteristics of the care team and the organization content and delivery method of the DMP which are crucial to enhance the discharge outcomes of older people with heart failure.

A striking rise in the incidence and prevalence of congestive heart failure (CHF) in the Chinese population has been reported. While promoting the quality of life (QOL) of these patients is widely recognized as an important clinical priority, there is not a validated Chinese disease-specific QOL measure for CHF patients. The aim of this study was to validate the Chinese version of Chronic Heart Failure Questionnaire (CHQ-C) which measures the disease-specific QOL of patients with CHF. A sample of 110 CHF elderly patients and a comparison group of 64 healthy elderly people was recruited. Structured questionnaires were administered by a research nurse. Criterion and construct validity of CHQ-C was demonstrated by its significant correlation with the New York Heart Association classification (Spearman r = -0.52, p < 0.001) and the Chinese version of Hospital Anxiety and Depression scale (Pearson r = -0.74, p < 0.001), respectively. Known-groups comparison also demonstrated the ability of CHQ-C to differentiate the QOL of people with or without CHF. Confirmatory factor analysis supported the original four-factor structure of CHQ. In terms of internal consistency and test-retest reliability, CHQ-C demonstrated a Cronbach's alpha of 0.95 and an intraclass correlation coefficient (ICC) of 0.75, respectively. The responsiveness coefficient of CHQ-C was 0.63. In conclusion, CHQ-C is recommended as a valid and reliable tool for evaluating the QOL of Chinese patients with CHF.

Background: Despite abundant evidence attesting to poor physical, psychological and social functioning of congestive heart failure (CHF) patients, little is known about the impact of the disease itself on health-related quality of life (HRQL). Most previous work has focused on general quality of life issues rather than specifically on the impact of CHF on HRQL., Aim: To identify the significant demographic, clinical and psychosocial factors associated with HRQL in patients with CHF., Methods: A total of 227 CHF patients were recruited from the medical unit of a general hospital in Hong Kong. Cross-sectional data on HRQL, functional status, psychological state, social support and health perception were obtained from each patient and clinical data were obtained from hospital records., Results: In hierarchical regression analysis, psychological distress, poor health perception, higher NYHA grading and lower education level were identified as the significant factors associated with poorer HRQL. These correlates in total explained 52% of the variance for the HRQL scores. Among these correlates, psychological distress and NYHA grading demonstrated the greatest effect on HRQL scores., Conclusion: The findings highlight the significance of addressing the psychological and functional health of CHF patients. Assisting these patients to cultivate a positive attitude towards their own health status is also an important treatment goal.

Objective: High levels of psychological distress have been reported in patients with congestive heart failure (CHF), resulting in increased morbidity and mortality. Yet, little is known about its associated factors. The purpose of this study is to identify the significant demographic, clinical and psychosocial correlates of psychological distress in CHF patients., Methods: Cross-sectional data were obtained from a sample of a consecutive series of hospitalized CHF patients (n = 227) with measures of psychological distress, functional status, symptom status, social support and health perception. Objective clinical variables were obtained from the hospital records., Results: High levels of psychological distress, in particular, depression, were found in patients with CHF. In hierarchical regression analysis, poorer perceived emotional-informational support, higher levels of fatigue, poorer health perception and not living with family were identified as the significant correlates of psychological distress. These correlates, in total, explained 49% of the variance for the scores of psychological distress. None of the objective clinical variables demonstrated a significant contribution that accounted for psychological distress in CHF patients., Conclusion: The findings highlight the importance of addressing social support for CHF patients. Assisting this vulnerable patient group to cope with fatigue and to cultivate a positive health perception are also highly prioritized treatment goals.

Heart failure (HF) has a profound impact on patients' health-related quality of life (HRQL). Little is known about factors relating to HRQL in elderly Chinese HF patients. The objective of this cross-sectional correlational study was to identify the demographic, psychosocial, and clinical factors associated with HRQL in this group of patients. Cross-sectional data were obtained from a consecutive sample of hospitalized HF patients (n = 227) with measures of HRQL, psychological distress, perceived social support, and health perception. Functional status was measured with the New York Heart Association Classification (NYHA). In stepwise regression analysis, four variables, including psychological distress, health perception, NYHA classification, and educational level explained 51.8% (p =.01) of the variance in HRQL. These findings suggest that improving HRQL of HF patients entails improving their psychological status, functional status, and health perception., (Copyright 2004 Wiley Periodicals, Inc.)

The Brislin's model of translation is recommended as the most reliable method for developing an equivalent translated instrument. This article describes its application in translating the Chronic Heart Failure Questionnaire (CHQ) from English to Chinese. The equivalence of translation of the CHQ is established. The methodological issues and difficulties encountered in the translation process are discussed.

Background: Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment. Yet, there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure. Objective: To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients. Methods: Subjects undertook relaxation (n = 59), exercise training (n = 32) or received attention placebo (n = 62) for 12 weeks. The relaxation group attended two training sessions, one revision workshop, and continued with twice-daily taped-directed home relaxation practice, with support from the intervener through bi-weekly telephone contact, for 12 weeks. The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise. The control group received regular telephone calls for general ‘greetings’. Results: The relaxation and exercise groups reported a significantly greater improvement in psychological [F(2, 149) = 6.69, p = 0.002] and various disease-specific quality of life outcomes [dyspnea: F(2, 149) = 5.72, p = 0.004; fatigue: F(2, 149) = 3.78, p = 0.25; emotion: F(2, 149) = 6.68, p = 0.001], compared with those who received the attention placebo. While relaxation therapy was more effective to reduce psychological distress, with depression in particular (p < 0.001), exercise therapy worked better to control fatigue symptoms (p = 0.03). Conclusion: Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients. They should be used as an individual treatment modality, or as care components of a disease management program. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Presents a letter to the editor regarding the establishment of the reliability and validity of the Chinese version of the Medical Outcomes Study Social Support Survey in older patients with heart failure.