{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T17:28:43Z","timestamp":1787074123015,"version":"build-2736575974"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n BACKGROUND:<\/jats:title>\n Heart failure (HF) is a chronic and progressive condition associated with significant physical limitations, psychological distress, and impaired quality of life (QoL). Despite advances in medical management, many patients continue to experience persistent symptoms and elevated stress levels. This study aimed to evaluate the effect of a comprehensive therapeutic milieu on QoL and stress level among patients with HF.<\/jats:p>\n <\/jats:sec>\n \n MATERIALS AND METHODS:<\/jats:title>\n \n A true experimental pretest\u2013posttest control group design was used. The sample size (\n n<\/jats:italic>\n = 240) was calculated based on 80% power, a 5% level of significance, and a medium effect size (Cohen\u2019s\n d<\/jats:italic>\n = 0.5). Participants were allocated to study and control groups using stratified randomization based on age and gender. The intervention group received a 90-day comprehensive therapeutic milieu, while the control group received routine care.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n At pretest, most participants in both groups reported poor QoL and moderate stress levels. By posttest, the study group demonstrated significant improvement in the physical dimension, emotional dimension, and overall QoL compared to the control group (\n P<\/jats:italic>\n < 0.001). The mean stress score in the study group decreased from 23.28 \u00b1 3.85 at baseline to 16.57 \u00b1 4.22 at posttest III, whereas the control group showed minimal change. A moderate positive correlation was observed between stress and QoL scores (\n r<\/jats:italic>\n = 0.571 in the study group;\n r<\/jats:italic>\n = 0.658 in the control group,\n P<\/jats:italic>\n < 0.001), indicating that increased stress is associated with poorer QoL as higher scores on both scales represent worse outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n The study finding concluded that integrating structured psychosocial support and low-intensity physical activity into routine cardiac care may enhance holistic management and improve long-term patient outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jehp.jehp_588_26","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:02:20Z","timestamp":1785484940000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of a comprehensive therapeutic milieu on quality of life and level of stress among patients with heart failure - An experimental study"],"prefix":"10.4103","volume":"15","author":[{"given":"Shoba","family":"Govindasamy","sequence":"first","affiliation":[{"name":"Meenakshi Academy of Higher Education and Research (Deemed to be University) Chennai, Tamil Nadu, India"},{"name":"Department of Medical Surgical Nursing, MMM College of Nursing, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayalvizhi","family":"Elumalai","sequence":"additional","affiliation":[{"name":"Department of Physiology, Meenakshi Medical College, Kanchipuram, Meenakshi Academy of Higher Education and Research (Deemed to be University) Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seethalakshmi","family":"Avudaiappan","sequence":"additional","affiliation":[{"name":"Department of Nursing Foundation, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaline","family":"Rachel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Nursing, MMM College of Nursing, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"issue":"17","key":"R1-20260818","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: A comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc Res."},{"key":"R2-20260818","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"issue":"3","key":"R3-20260818","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1136\/heart.87.3.235","article-title":"Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables","volume":"87","author":"Juenger","year":"2002","journal-title":"Heart."},{"key":"R4-20260818","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/JCN.0000000000000350","article-title":"Caregiver well-being and patient outcomes in heart failure: A dyadic analysis","volume":"32","author":"Bidwell","year":"2017","journal-title":"J Cardiovasc Nurs"},{"issue":"3","key":"R5-20260818","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s10741-020-10056-8","article-title":"Psychological stress in heart failure: A potentially actionable disease modifier","volume":"26","author":"Harris","year":"2021","journal-title":"Heart Fail Rev."},{"issue":"7","key":"R6-20260818","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1002\/ejhf.3440","article-title":"Quality of life in heart failure: The heart of the matter. 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