Home-based nurse-led self-management support for heart failure: a randomized controlled trial.

AIM: To evaluate the effect of a nurse-led, stage-tailored home-based self-management and follow-up programme on self-care behaviour in people with heart failure. BACKGROUND: People with heart failure require ongoing education, symptom monitoring, and self-management support after specialist assessment. However, access to structured centre-based cardiac rehabilitation may be limited. A nurse-led home-based model may help bridge the gap between specialist cardiology care and community-based long-term support, particularly where rehabilitation services are unavailable. METHODS: In this parallel-group randomized controlled trial, adults aged 40-75 years with New York Heart Association class I-III heart failure and ejection fraction >30% were allocated to a 12-week home-based programme or usual care. The intervention was delivered through nurse-led home visits and telephone follow-up for clinically stable patients who could not access structured centre-based rehabilitation. The intervention group received home visits and telephone follow-up (n = 32), while the control group received usual care (n = 31). The primary outcome was self-care behaviour. Secondary outcomes were quality of life, self-efficacy, and physical capacity. Exploratory clinical outcomes were body composition, ejection fraction, and HbA1c level. FINDINGS: At 12 weeks, the intervention group had better self-care scores than the control group (17.78 ± 2.93 vs 40.00 ± 6.49). Secondary outcomes also favoured the intervention group, with better quality of life scores, higher self-efficacy scores, and greater 6-minute walk distance. Exploratory clinical outcomes showed changes in some parameters, including ejection fraction and body-fluid values. Most intervention participants reached the Transtheoretical Model action stage, and New York Heart Association class improved significantly. This primary health care-relevant home-based model was associated with improved self-care behaviour and may support continuity of care for people with heart failure after specialist cardiology assessment when centre-based rehabilitation is unavailable. CONCLUSION: The programme improved self-care in people with heart failure and showed potential to support home-based self-management when centre-based cardiac rehabilitation was unavailable.