Patients who were admitted to the cardiology
unit of the University Hospital of Maastricht with
symptoms of heart failure were potentially eligible
for the study. After verifying the diagnosis with the
Boston score,23 patients were included in the study
if they met the following criteria: New York Heart
Association (NYHA) functional class III and IV; heart
failure diagnosis for longer than 3 months; 50 years
of age or older; and Dutch literacy. Patients were
excluded from the study if they suffered from a
coexisting, severe, chronic debilitating disease; if
they were discharged to a nursing home; if they had
a psychiatric diagnosis; and if they had a previous
CABG, angioplasty, or valve replacement in the last
6 months or were expecting to have such treatment
within 3 months. The institutional review boards
approved the study