Integrated Nursing Program Improves Symptom Distress, Depression, and Heart Rate Variability in Patients with Heart Failure

Monday, 9 November 2015

Hui Ling Hsieh, MSN, RN
Department of Nursing, Wan Fang Hospital, Taiwan, Taipei, Taiwan
Chi-Wen Kao, PhD, RN
School of Nursing, National Defense Medical Center, Taiwan, Taipei, Taiwan

Background: Physical symptoms of heart failure impair patients’ functional capacity and affect their psychosocial well-being. A common comorbidity in heart failure patients is depression. Depression may contribute to a poor prognosis for patients with heart failure. In fact, depression is related to increased morbidity and mortality in patients with heart failure.

Purpose: The aim of this study was to examine the effect of a "Integrated Nursing Program" on symptom distress, depression and heart rate variability (HRV) in patients with heart failure.

Methods: Total of 78 heart failure patients participated in this longitudinal experimental study. The subjects in experimental group (n= 36) received the "Integrated Nursing Program", and subjects in control group (n= 42) received routine care. Data were collected at four times: baseline, and one time per month for three months. The Beck Depression Inventory-II was used to measure the depressive symptoms. The Generalized Estimating Equation (GEE) was used to analyze the effect of the "Integrated Nursing Program" on symptom distress, depression, and heart rate variability.

Results: The majority of subjects were male (58.5%), with New York Heart Association class II (75.6%), a mean age 71.04 ± 11.01 years, and left ventricular ejection fraction 51.80±11.13%. The patients receiving the "Integrated Nursing Program" have a significant decrease in the symptom distress (x2= 4.792, p= .029), and depressive symptom (x2= 3.668, p= .05), compared to the patients without obtaining this program. Even though the heart rate variability was not significantly increased in experimental group patients when compared with the control group patients, there was an improvement trend in heart rate variability.

Conclude: The"Integrated Nursing Program" is able to decrease the symptom distress and depression, and improve the heart rate variability in patients with heart failure. The clinicians may use this program to instruct heart failure patients how to deal with their symptoms and self-care.