Abstract

Background
Heart failure has an estimated global prevalence of 64.3 million cases, with an average age of a person living with heart failure at 75.2 years. Approximately 20% of residents living in nursing homes (a long-term residential care environment for some individuals) report living with heart failure. Residents living with heart failure in nursing home environments are often frail, have reduced quality of life, higher rates of rehospitalisation and mortality, and greater complications in heart failure management. Further, nursing home staff often lack the knowledge and skills required to provide the necessary care for those living with heart failure. Interventions for improving heart failure management in nursing homes have proven effective, yet there is a lack of understanding regarding interventions for optimising care provision. The aim of this review was to synthesise the current evidence on educational interventions to optimise care provided to people with heart failure in nursing homes.

Methods
A scoping review with four databases searched: Medline, CINAHL, Web of Science, and EMBASE. Relevant reference lists were searched manually for additional records. Studies of nursing home staff or resident outcomes associated with changes in care provision (i.e., resident quality of life, staff knowledge of heart failure) were included. Results from the charting data process were collated into themes: intervention outcomes, changes to practice, and implementation and process evaluation.

Results
Seven papers were deemed eligible for inclusion. Most studies (n=6) were comprised of nursing home staff only, with one comprised only of residents. Study aims were to improve heart failure knowledge, interprofessional communication, heart failure assessment and management. Positive changes in staff outcomes were observed, with improvements in knowledge, self-efficacy, and confidence in providing care reported. No difference was reported concerning nursing home resident outcomes. Interprofessional communication and staff ability to conduct heart failure assessments improved post-intervention. Changes to practice were mixed, with issues around sustainability reported. Nursing home staff highlighted their appreciation towards receiving education, recommending that videos, images, and humour could improve the intervention content.

Conclusions
There is a paucity of evidence around educational interventions to support residents living with heart failure in nursing homes. However, available evidence suggests that educational interventions in nursing homes may improve care through improving staff self-efficacy and confidence in providing care, heart failure knowledge and interprofessional communication. The complexity of implementing educational interventions in the nursing home setting must be considered during the development process to improve implementation, effectiveness, and sustainability.

Background

Heart failure, defined as a clinical syndrome characterised by structural and/or functional changes to the heart (Bozkurt et al., 2021), has an estimated prevalence of 64.3 million cases worldwide (Savarese et al., 2022). People living with heart failure often present with three or more comorbidities, such as hypertension, diabetes mellitus and chronic kidney disease, which increases the severity of heart failure symptoms and negatively impacts quality of life and prognosis (Groenewegen et al., 2020). The presence of multi-comorbidities increases the complexity to effectively manage patients with heart failure (Conrad et al., 2018). Consequently, difficulties in management have resulted in higher rates of rehospitalisation (Groenewegen et al., 2020, Komajda, 2015, Wachter and Rommel, 2022), placing a significant demand on hospital facilities and personnel, and incurring substantial healthcare costs (Cleland et al., 2019, Conrad et al., 2018, Lesyuk et al., 2018, Urbich et al., 2020).

Due to an ageing population, improvements in diagnostic testing, and greater survival rates following a cardiovascular event, the incidence of heart failure is expected to continue to rise (Lippi and Sanchis-Gomar, 2020, Savarese et al., 2022). The prevalence of heart failure increases with age, from 1% for those <55 years to 10% for those aged >70 years (McDonagh et al., 2021). In the USA between 2001 and 2014, of the 14.6 million individuals hospitalised due to heart failure, 75.3% were classified as older people (>65 years) (Akintoye et al., 2017). The mean age of this population is 75.2 years (Norhammar et al., 2023).

Conclusions

The findings from this review highlight the potential of interventions implemented in nursing homes for improving care provision to residents with heart failure. However, outcomes reported across the included studies were mostly focused on nursing home staff. Thus, future research is needed to determine whether such interventions are effective in improving outcomes associated with nursing home residents. Also, future research should aim to determine whether such interventions can produce long-term effects and sustainability. Education was a common intervention component employed across the studies, provided face-to-face to nursing home staff. Participant feedback, although limited, indicated that education was well-received and beneficial, improving heart failure knowledge of staff. However, this study reported poor participant attendance at the sessions, with the intervention facilitator indicating that this approach was burdensome. The delivery of a digital intervention may provide greater success, reducing the burden on staff and the need for an intervention facilitator. A digital approach also provides participants with the ability to access the intervention at a time that suits them, potentially improving intervention acceptability, user engagement, and likelihood of success.