Heart failure patients are a group of chronic patients whose number is growing. The aging of the population, the increasing chances of surviving acute cardiac problems and the improved recognition of heart failure have resulted in increased numbers of chronic heart failure patients.
Heart failure is described as a complex clinical syndrome rather than an objective definable disease, and it is frequently characterized as the complex of symptoms that are related to the inadequate perfusion of tissue during exertion and often to retention of fluid. Heart failure patients often suffer from symptoms like breathlessness or fatigue, either at rest or during exertion, or/and ankle swelling. These symptoms have a major impact on the daily life of patients and their families. In addition, treatment, life-style changes, and insecure prognosis have a large influence on their lives.
The growth in the number of patients with heart failure necessitates a shift in the emphasis of the health care system. In addition to the increased need for diagnosis and medical treatment, there is a growing emphasis on care and adequate follow-up of the chronic patient population. Different strategies are used to advance quality of care, improve patient outcomes and decrease use of resources. Nurses are increasingly involved in these new care initiatives that often are aimed at improving continuity of care between hospital and home. Although several models of care are described and are expected to improve care, no randomized Dutch studies have been reported that evaluate the effect of nursing care in a heart failure population.
In this thesis the importance of education and support is described and the develop- ment of a standard nursing care plan for patients with chronic heart failure is presented. Finally the results of a study evaluating the effects of education and support in a heart failure population are presented. The first part of the thesis describes the background of the study.

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