A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes

Abstract

A B S T R A C T Background:Having support from an informal carer is important for heart failure patients. Carers have the potential to improve patient self-care. At the same time, it should be acknowledged that caregiving could affect the carer negatively and cause emotional reactions of burden and stress. Dyadic (patient and informal carer) heart failure self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom management when needed. Currently, no systematic assessment of dyadic interventions has been conducted with a focus on describing components, examining physical and delivery contexts, or determining the effect on patient and/or carer outcomes.Objective: To examine the components, context, and outcomes of dyadic self-care interventions.Design: A systematic review registered in PROSPERO, following PRISMA guidelines with a narrative analysis and realist synthesis. Data Sources: PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases for the following concepts: dyadic, carers, heart failure and intervention. Eligible studies were original research, written in English, on dyadic self-care interventions in adult samples. Review methods:We used a two-tiered analytic approach including both completed studies with power to determine outcomes and ongoing studies including abstracts, small pilot studies and protocols to forecast future directions.Results: Eighteen papers -12 unique, completed intervention studies (two quasi-and ten experimental trials) from 2000 to 2016 were reviewed.Intervention components fell into three groups -education, support, and guidance. Interventions were implemented in 5 countries, across multiple settings of care, and involved 3 delivery modes -face to face, telephone or technology based. Dyadic intervention effects on cognitive, behavioral, affective and health services utilization outcomes were found within studies. However, findings across studies were inconclusive as some studies reported positive and some non-sustaining outcomes on the same variables. All the included papers had methodological limitations including insufficient sample size, mixed intervention effects and counter-intuitive outcomes. Conclusions:We found that the evidence from dyadic interventions to promote heart failure selfcare, while growing, is still very limited. Future research needs to involve advanced sample size justification, innovative solutions to increase and sustain behavior change, and use of mixed methods for capturing a more holistic picture of effects in clinical practice. Contribution of the paper:What is already known about the topic?• Having support from an informal carer is important for heart failure (HF) patients • Dyadic (patient and informal carer) HF self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom...

Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self‐care: impact on outcomes

“…36,37 On the contrary, other showed greater risk of hospitalization associated with better self-care, suggesting that more consistent engagement in self-care behaviours is driven in part by the progressive nature of HF. 38 In fact, few studies have demonstrated a reduction in readmission rates based on HF self-care education even in a dyadic way, including the caregiver, 39,40 and the use of self-management programmes have also shown inconsistent effects on outcomes even if most of these studies enrolled patients younger than those enrolled in our cohort. 14,40,41 Also, a meta-analysis including the most relevant studies showed that self-management interventions may be less beneficial in older than in younger patients, may not benefit or even cause harm in patients with depression, or may not improve key outcomes (i.e.…”

Involving caregivers in self‐management interventions for patients with heart failure and chronic obstructive pulmonary disease. A systematic review and meta‐analysis

“…Engagement with both pulmonary and cardiac rehabilitation has demonstrated positive improvements in patient HRQoL (Casaburi, ; Sagar et al, ). Existing evidence is conflicting regarding the success of the intervention and lacks clarity about the extent of the involvement of caregivers and the methodological rigour (Bryant et al, ; Buck et al, ; Evangelista, Strӧmberg, & Dionne‐Odom, ). A review of self‐management approaches for people with chronic conditions indicates that there is a gap in the literature with regard to caregivers and self‐management interventions (Barlow, Wright, Sheasby, Turner, & Hainsworth, ).…”

A body of work, a missed opportunity: Dyadic research in older adults

“…Finally, we highlight the absence of both the dyadic theoretical and review literature from this article. From a key theoretical article (cited 500+) by Berg and Upchurch in which a developmental and contextual dyadic chronic illness model was introduced to a recent international systematic review of dyadic interventions in which intervention components, contexts, and outcomes were examined, there is a rich body of work that was not brought to the attention of the readers of this article. One particular article, by Lyons and Lee, exemplifies this issue.…”