The importance and impact of social support on outcomes in patients with heart failure:an overview of the literature

As advances in medical treatment of heart failure (HF) become limited, other factors are being studied to improve outcomes. There is much evidence that supportive social relations have a major impact on health outcomes and that social support is essential for adjustment to illness. This article describes current research on the influence of social support on outcomes in patients with HF. A computerized literature search in Medline, CINAHL, and PsychLit was performed on each of the different outcomes in relation to social support, covering the period 1993 to 2003. Seventeen studies were found that investigated the relationship between social support and different outcome measures in HF. Four studies found clear relationships between social support and rehospitalizations and mortality; the relationship between quality of life and depression was less clear. Up to now, limited research has been done on the impact of social support on outcomes in patients with HF. The available studies suggest that social support has an impact on HF outcomes but further research is necessary before firm conclusions about the nature of these relationships can be reache

Waarde van lichte en intensieve begeleiding van patienten met hartfalen; resultaten van het COACH-onderzoek.

OBJECTIVE: To determine the efficacy of 2 nurse-directed programmes of different intensity for the counselling and follow-up of patients hospitalised for heart failure, compared with standard care by a cardiologist. DESIGN: Multicentre randomised clinical trial (www.trialregister.nl: NCT 98675639). METHOD: A total of 1023 patients were randomized after hospitalisation for heart failure to 1 of 3 treatment strategies: standard care provided by a cardiologist, follow-up care from a cardiologist with basic counselling and support by a nurse specialising in heart failure, or follow-up care from a cardiologist with intensive counselling and support by a nurse specialising in heart failure. Primary end points were the time to rehospitalisation due to heart failure or death and the number of days lost to rehospitalisation or death during the 18-month study period. Data were analysed on an intent-to-treat basis. RESULTS: Mean patient age was 71 years, 38% were women, 50% had mild heart failure and 50% had severe heart failure. During the study, 411 patients (40%) were rehospitalised due to heart failure or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (differences not significant). The time to rehospitalisation or death was similar in the 3 groups: hazard ratios for the basic and intensive support groups versus the control group were 0.96 (95% CI: 0.76-1.21; p = 0.73) and 0.93 (95% CI: 0.73-1.17; p = 0.53), respectively. The number of days lost to rehospitalisation or death was 39,960 in the control group; this number was 15% less in the intervention groups, but the difference was not significant. However, there was a trend toward lower mortality in the intervention groups. In all 3 groups, more visits occurred than planned, which may have had a considerable effect on care, notably in the control group. CONCLUSION: The results of this study indicated that the provision of additional counselling and support by a nurse specialising in heart failure as an adjuvant to intensive follow-up care provided by a cardiologist does not always lead to a reduction in rehospitalisation frequenc