Outcomes of an Advanced Practice Nurse-Led Continuing Care Program in People with Heart Failure

Main Article Content

Jittawadee Rhiantong
Porntip Malathum
Supreeda Monkong
Kathleen McCauley
Chukiat Viwatwongkasem
Srun Kuanprasert


                  Heart failure is a serious, chronic, and complex condition requiring continuing care. Therefore, advanced practice nurses play a key role to improve the healthcare quality for this population. The purpose of this quasi-experimental study was to compare outcomes of persons with heart failure receiving the Continuing Care Program led by advanced practice nurses and those receiving usual care. Purposive sampling was used to recruit people with heart failure from a university hospital in Thailand. The participants numbered 29 and 42 in the comparison and intervention groups, respectively. The study outcomes included: body weight changes, complications, functional status, quality of life, satisfaction with nursing care, emergency room visits, time interval between discharge and the first readmission, readmission rate, length of stay, and cost of care assessed at hospital discharge and three-months post-discharge Data were analyzed using descriptive statistics, nonparametric tests, t-test, and regression analysis.

                  Results revealed that functional status, quality of life, and patient satisfaction with nursing care in the intervention group were significantly higher, whereas length of stay and cost of care were significantly lower than those in the comparison group. Therefore, the Advanced Practice Nurse-Led Continuing Care Program holds promise for improving population-based care outcomes for those with complicated chronic health problems such as heart failure.

Article Details

How to Cite
Rhiantong J, Malathum P, Monkong S, McCauley K, Viwatwongkasem C, Kuanprasert S. Outcomes of an Advanced Practice Nurse-Led Continuing Care Program in People with Heart Failure. PRIJNR [Internet]. 2018 Dec. 19 [cited 2023 Jan. 30];23(1):32-46. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/119723
Original paper


1. Roger VL. Epidemiology of heart failure. Circ Res. 2013; 113(6): 646-59.

2. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013; 6(3): 606-19.

3. Laothavorn P, Hengrussamee K, Kanjanavanit R, Moleerergpoom W, Laorakpongse D, Pachirat O, et al. Thai acute decompensated heart failure registry. CVD Prev Control. 2010; 5: 89-95.

4. Piepoli MF, Guazzi M, Boriani G, Cicoira M, Corrà U, Dalla Libera L, et al. Exercise intolerance in chronic heart failure: mechanisms and therapies. Part I. Eur J Cardiovasc Prev Rehabil. 2010; 17(6): 637-42.

5. Stanley M, Prasun M. Heart failure in older adults: keys to successful management. AACN Clin Issues. 2002; 13(1): 94-102.

6. Hodges P. Factors impacting readmissions of older patients with heart failure. Crit Care Nurs Q. 2009; 32(1): 33-43.

7. Levenson JW, McCarthy EP, Lynn J, Davis RB, Phillips RS. The last six months of life for patients with congestive heart failure. J Am Geriatr Soc. 2000; 48(5 Suppl): S101-9.

8. Zambroski CH, Moser DK, Bhat G, Ziegler C. Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure. Eur J Cardiovasc Nurs. 2005; 4(3): 198-206.

9. McCormick SA. Advanced practice nursing for congestive heart failure. Crit Care Nurs Q. 1999; 21(4): 1-8.

10. Swan M, Ferguson S, Chang A, Larson E, Smaldone A. Quality of primary care by advanced practice nurses: a systematic review. Int J Qual Health Care. 2015; 27(5): 396-404.

11. Aaron EM, Andrews CS. Integration of advanced practice providers into Israeli healthcare system. Isr J Health Policy Res. 2016; 22(5): 7.

12. Parker J M, Hill MN. A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong special administrative region (SAR), China. Int J Nurs Sci. 2017; 4, 196-204.

13. Fougere B, et.al. Development and implementation of the advanced practice nurse worldwide with an interest in geriatric care. J Am Med Dir Assoc. 2016; 17(9), 78288.

14. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized controlled trial. J Am Geriatr Soc. 2004; 52(5): 675-84.

15. Kwok T, Lee J, Woo J, Lee DT, Griffith S. A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failure. J Clin Nurs. 2008; 17 (1): 109-17.

16. Thompson DR, Roebuck A, Stewart S. Effects of a nurseled, clinic and home-based intervention on recurrent hospital use in chronic heart failure. Eur J Heart Fail. 2005; 7(3): 377-84.

17. Kim SM, Han HR. Evidence-based strategies to reduce readmission in patients with heart failure. J Nurse Pract. 2013; 9(4): 224-32.

18. Whitaker-Brown CD, Woods SJ, Cornelius JB, Southard E, Gulati SK. Improving quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-tocare clinic. Heart Lung. 2017; 46(2):79-84.

19. Sezgin D, Mert H, Özpelit E, Akdeniz B. The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: a randomized controlled trial. Int J Nurs Stud. 2017; 70: 17-26.

20. Moser DK, Dickson V, Jaarsma T, Lee C, Stromberg A, Riegel B. Role of self-care in the patient with heart failure. Current Cardiology Reports. 2012; 14(3): 265–75.

21. Osevala ML. Advance-practice nursing in heart-failure management: an integrative review. J Cardiovasc Manag. 2005; 16(3): 19-23.

22. Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L. Systematic review of multidisciplinary interventions in heart failure. Heart. 2005; 91: 899-906.

23. Case R, Haynes D, Holaday B, Parker VG. Evidence-based nursing: The role of the advanced practice registered nurse in the management of heart failure patients in the outpatient setting. Dimens Crit Care Nurs. 2010; 29(2): 57-62.

24. Byers JF, Brunell ML. Demonstrating the value of the advanced practice nurse: an evaluation model. AACN Clin Issues. 1998; 9(2): 296-305.

25. Ingersoll GL, McIntosh E, Williamsl M. Nurse-sensitive outcomes of advanced practice. J Adv Nurs. 2000; 32(5): 1272-81.

26. Brooten D, Gordon Y. Editorial: documenting and communicating advanced practice nurses’ effectiveness. Pacific Rim Int J Nurs Res. 2018; 22(1): 1-5.

27. Irvine D, Sidani S, Hall LM. Linking outcomes to nurses’ roles in health care. Nurs Econ. 1998; 16(2): 58-64, 87.

28. Donabedian A. Exploration in quality assessment and monitoring: the definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press; 1980.

29. The Criteria Committee of the New York Association. Functional capacity and objective assessment. In: Dolgin M, editor. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels 9 th ed. Boston: Little, Brown and Company; 1994. p. 253-55.

30. Rector T, Kubo S, Cohn J. Patient’s self-assessment of their congestive heart failure. Part 2: content, reliability and validity of a new measure, The Minnesota Living with Heart Failure Questionnaire. Heart Failure. 1987; 1: 198-219.

31. Tangsatitkiat W, Sakthong P. The content improvements of the Thai version of the Minnesota Living with Heart Failure Questionnaire Using Cognitive Interview. Thai Pharm Health Sci J. 2009; 4(2): 227-35. [in Thai]

32. Tangsatitkiat W, Sakthong P. Thai version of the Minnesota Living with Heart Failure Questionnaire: psychometric testing using a longitudinal design. Asian Biomedicine. 2010; 4(6): 877-84.

33. Suwisith N, Hanucharurnkul S. Development of the Patient Satisfaction with Nursing Care Questionnaire. Rama Nurs J. 2011; 17(2): 264-77. [in Thai]

34. Wang S, Zhao Y, Zang X. Continuing care for older patients during the transitional period. Chin Nurs Res. 2014; 1: 5-13.

35. Koukoui F, Desmoulin F, Lairy G, Bleinc D, Boursiquot L, Galinier M, et al. Benefits of cardiac rehabilitation in heart failure patients according to etiology. Medicine (Baltimore). 2015; 94(7): e544.

36. Rauh RA, Schwabauer NJ, Enger EL, Moran JF. A community hospital-based congestive heart failure program: impact on length of stay, admission and readmission rates, and cost. Am J Manag Care. 1999; 5(1): 37-43.

37. Bull MJ, Hansen HE, Gross CR. Predictors of elders and family caregiver satisfaction with discharge planning. J Cardiovasc Nurs. 2000; 14(3): 76-87.

38. McDonald K, Ledwidge M, Cahill J, Quigley P, Maurer B, Travers B, et al. Heart failure management: multidisciplinary care has intrinsic benefit above the optimization of medical care. J Card Fail. 2002; 8(3): 142-8.

39. Arrigo M, Parissis JT, Akiyama E, Mebazaa A. Understanding acute heart failure: pathophysiology and diagnosis. Eur Heart J Suppl. 2016; 18: G11-18.

40. Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al. Comprehensive discharge planning and home follow-up hospitalized elders: a randomized clinical trial. JAMA. 1999; 281: 613-20.