Tailoring the care in patients with chronic heart failure: a feasibility study on psychological support at distance

Continuity of care at home is essential for the management of patients with chronic heart failure (CHF) suffering also from anxiety/depressive symptoms. This study was aimed at evaluating the possibility of providing psychological support to CHF patients after hospital discharge. A psychodynamic model of counselling was approached by telephone by a psychotherapist and evaluated in terms of feasibility. 16 out 67 CHF patients who continue to suffer from mild to moderate anxiety/depressive disorders, which, because of location, transports or infirmity impediments, could not have access to any other care support, were enrolled in this feasibility study. At time of discharge, every 7–10 days for a pilot period of 6 months, patients were followed by a telephone call (lasting 45 min, as an in office visit) by the same psychotherapist who had previously performed in-hospital interview and tests. Evaluation of anxiety and depression and quality of life were performed by appropriate tests (Hospital Anxiety and Depression Scale and WHOQOL-Brief, respectively), questionnaires of satisfaction by patients and operator were also provided. There were 109 total contacts/6 months, with an average of 6.8 ± 3.6 calls per patient. 82 out of 109 calls (75%) were managed in the first 3-month period. Main areas of discussion were the insight and experience of disease and interaction with the health staff. At the end of the 6-month study, six patients needed further specific psychotherapist’s support and the programme was extended till 1 year (42 further calls). More than 90% patients were satisfied of the service. Operator encountered difficulties mainly due to schedule contacts during working time for worker patients. This preliminary study shows the assessment and feasibility of the psychodynamic counselling by telephone in CHF patients which needs further organizational improvement.