Evaluation of a health service system for heart failure management in Thailand

Health service systems worldwide face challenges to improve the functional health of patients with heart failure. A heart failure management policy has recently been launched in Thailand. This study aimed to evaluate the effectiveness of this policy focusing on the functional capacity of these patients, and to identify the multilevel factors influencing their functional capacity. A cross-sectional design using a multilevel approach was used. Questionnaires and a six-minute walk test were performed with 413 patients with heart failure at 13 cardiac outpatient clinics from tertiary hospitals located in the Bangkok metropolitan area and the central part of Thailand. Descriptive statistics and multilevel linear regression were used to analyze the data. The results revealed that the mean six-minute walk distance (269.2±126.6 m) of the participants indicated a low level of functional capacity. Sex, age, severity of co-morbidity (p < 0.001), self-care, and adequacy of income (p < 0.05) significantly influenced the functional capacity. Participants receiving heart failure management provided by cardiologists and cardiac nurses undergoing a 4-month cardiovascular course performed a longer walk distance than those receiving care from cardiologists and general nurses (p < 0.05). To maximize the functional capacity of patients with heart failure, their diversity and the integration of a specialized care team are vital for effective HF management at all cardiac clinics.