Importance of Psychological Interventions, Medication Adherence, and Exercise-based Rehabilitation for Heart Failure Patients

This annotated bibliography explores the impact of psychological interventions, medication adherence, and exercise-based rehabilitation on the overall health outcomes of heart failure patients. It reviews various studies and highlights the effectiveness of these interventions in improving self-care, psychological health, and quality of life. The bibliography also provides recommendations for clinical practice.

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Annotated Bibliography
Name of the Student
Name of the University
Author Note

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Part 1
The systematic review of the randomised control trial, conducted by Jiang, Shorey,
Seah, Chan, Tam and Wang (2018) aimed towards examining the overall impact of the
psychological interventions in increase the provision of self-care, psychological health and
overall health outcomes of the patients who have encountered chronic heart failure (CHF).
The authors reviewed 29 randomised control trial (RCT) articles that are published with the
last 10 years. While the selection of the articles within the last 10 years helped the author to
provide the current approach of the evidence based practice, but a total of 29 articles showed
a reduced sample size that might lead to biased results (Parahoo, 2014). The analysis of the
RCT studies showed that psychological interventions are effective in improving the overall
skills of self-care among the CHF patients. However, the significance is only positively
associated with the patients who are free from cognitive problems and clinical depression.
The study also revealed that implementation of the psychological interventions help to
improve the comprehensive health and well-being by improving health-related quality of life
of the patients. However, authors failed to highlight any significant correlation with the
psychological interventions and anxiety management. Moreover, the review of the articles
also failed to provide the underlying approach of how psychological interventions are helping
to improve the quality of life of post CHR patients.
The study conducted by Molloy et al. (2012) attempted to provide an evidence-based
practice in improving the overall medication adherence of the people suffering from
cardiovascular problems. The main study approaches selected by the authors include
systematic review of the randomized control trials. This is can be regarded as one of the
important strength of the study in the domain of the study design as systematic review of the
RCT falls under the level 1 of the evidence. The RCT studies that conducted a comparative

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analysis with the intervention group and the placebo group were selected for the review. The
main population of interests were adults (people who are 18 years old or above). The final
analysis of the 16 articles revealed that non-pharmacological intervention, which is successful
in increasing the patient’s adherence of the medication include increased provision for the
patient education. The review of the RCT studies however failed to highlight any valid
justification behind the simplification of the drug regime in improving therapy adherence of
the patient. In order to increase the level of patient engagement by education, patient centered
educational plan based on the behavioral needs of the patient is found to be effective. One of
the limitations of the study is poor sample size (Parahoo, 2014). This might be a reason why
the review failed to provide the detail perceptive of the therapy adherence in relation of
simplification of the drug regime.
Sagar et al. (2015) conducted a systematic review and meta-analysis in order to
update the Cochrane systematic review about the importance of the exercise-based cardiac
rehabilitation (CR) program for heart failure. A total of 33 trials were included in the review
consisting of 4740 participants. The papers were selected in such a way that it had a follow-
up period of 1 year. The selection of the study of a standard sample size can be considered as
one of its strength. However, having a long follow-up period is regarded as one of the
limitations as candidate dropouts occurs during the follow-up leading to decrease in the
overall sample size of the participants (Parahoo, 2014). The analysis of the results highlighted
that regular practice of mild to moderate physical activity under in CR program helps to
reduce the overall risk of the re-hospitalization of the heart failure patients. Meta-regression
analysis showed that overall benefits were independent in relation to the dosage and type of
exercise in the CR program along with the duration of the total follow-up of the trial. The
results also showed decrease rate in the overall hospitalization of the post-stroke patients for
further cardiac complications. However, the authors recommend an individual participant

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data meta-analysis in order to provide a confirmatory evidence for the importance of the
subgroup of the patients and program level characteristics (duration and intensity of exercise)
over the outcome.

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Part 2
The review conducted by Jiang, Shorey, Seah, Chan, Tam and Wang (2018) was
selected for this paper because it helps to get an idea regarding the importance of the
psychological interventions for improving the overall quality of life. In relation to this,
Steptoe, Deaton and Stone (2015) stated that mental health and well-being is a significant
influence over the physical well-being of the individuals with complex cardiovascular
problems. A person who is happy and free from unwanted tension or depression is more
likely to follow health lifestyle regime and self-care in order to improve the physical well-
being. William had a past history of hypertension, ischaemic cardiomyopathy and has been
experiencing shortness of breath for the past few days. However, he went for medical help
only when the conditions went more severe for example, visible signs of peripheral oedema.
This highlights that William lack self-awareness and skills of self-care. Thus implementation
of the psychological interventions will help to induce self-care and self-management skills in
William. In relation of the psychological interventions, Ward, White and Druss (2015) are of
the opinion that proper implementation of the psychological interventions helps to improve
the mental well-being of the people and thereby helping them to take active initiatives in
favour of their physiological health like abiding by healthy lifestyle regime and periodic
mentoring of vital signs and visit to doctor when needed. This helps to avoid chances of
encountering medical emergencies.
The systematic review of Molloy et al. (2012) was selected in order to highlight the
importance of the patient education in generation of the disease awareness and increase in
the tendency of the therapy adherence. The study conducted by de Melo Ghisi, Grace,
Thomas and Oh (2015) stated that proper education of the patients with chronic heart failure
in the domain disease prognosis helps to promote the therapy adherence and at the same time

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helps to decrease the chance of the rehospitalisation resulting from further cardiac
complications. Case study reveals that in spite of having the previous reported cases of the
chronic heart failure, Mr. William is over-weight. Thus it shows that he is not abiding the
therapy like for example promoting of physical activity to lose weight. The case study also
reveals that William was experiencing distressing symptoms for the past few days but
showed zero initiatives to contact doctors at that time and this lead to delayed reporting.
Powers et al. (2018) stated that proper education of the patient about disease prognosis helps
in identification of the early signs and symptoms of cardiovascular complications and thereby
helping to prevent the negative prognosis of the disease. Stanhope and Lancaster (2015)
argued that patient education given under the community health approach and in a culturally
competent manner is found to fetch positive results in the domain of effective self-
management of the disease.
The study of Sagar et al. (2015) was selected because it provides significant evidence
in the domain of importance of the physical exercise under the cardiac rehabilitation program
for improving the health-related quality of life of the cardiac patients. The analysis of the case
study reveals that William is over-weight. Owen et al. (2015) stated that older adults who are
over-weight patients are more vulnerable in developing cardio-vascular complications, as
they are more prone to develop atherosclerosis. Owen et al. (2015) further reported that
weight people who have previous history of cardio-vascular problems and are over-weight
are prone to disease reoccurrence. William, a 75-year old man was over-weight and has past
history of CHF. Thus promotion of physical activity practice through CR program will help
to reduce body weight of William and thereby helping to reduce body mass index (BMI).
Decrease in the BMI will help to reduce the breathing problems and hyper-tension and
thereby helping to decrease the severity of the cardiovascular disease.

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Part 3
The recommendation for the clinical practice includes recruitment of the home-based
physical exercise trainer for Mr. William and an occupational therapist in order to aid
William with person-centred physical exercise training regime. Practice of person-centred
approach of for devising of the physical activity regime helps to fetch improved outcome
(Sagar et al., 2015). The promotion of weight loss and maintenance of the healthy lifestyle
habits can be further facilitated by designing of the person centred health education program.
The education program will include dietary regime that will be helpful for William to
overcome his body weight. Since William is 75 years old it is recommended to avail a home
cooking help for William in order to abide by the diet regime. Commonwealth Home Support
Programme of Australian Government might be proved to be helpful for William (Australian
Government Department of Health, 2019). The psychological interventions of William must
be framed under the active supervision of the mental health professionals. Moreover,
informal caregivers must also be educated about the disease prognosis in order to take active
action at the time of emergency through identification of the early signs and symptoms (Piette
et al., 2015).

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References
Australian Government Department of Health. (2019). Aeging and Aged Care Service.
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de Melo Ghisi, G. L., Grace, S. L., Thomas, S., & Oh, P. (2015). Behavior determinants
among cardiac rehabilitation patients receiving educational interventions: An
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Jiang, Y., Shorey, S., Seah, B., Chan, W. X., Tam, W. W. S., & Wang, W. (2018).The
effectiveness of psychological interventions on self-care, psychological and health
outcomes in patients with chronic heart failure—A systematic review and meta-
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enhance adherence to medications in patients with heart failure: A systematic review.
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Owen, C. G., Kapetanakis, V. V., Rudnicka, A. R., Wathern, A. K., Lennon, L., Papacosta,
O., ... & Whincup, P. H. (2015). Body mass index in early and middle adult life:
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http://dx.doi.org/10.1136/bmjopen-2015-008105

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Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan
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Piette, J. D., Striplin, D., Marinec, N., Chen, J., & Aikens, J. E. (2015). A randomized trial of
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Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H. M., Lough, F., ... & Taylor, R.
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