Effects of nurse‐led self‐care interventions on health outcomes among people with heart failure: A systematic review and meta‐analysis

Abstract

AimTo estimate the effects of nurse‐led self‐care interventions on people with heart failure (HF).BackgroundResearch evidence of the effects of nurse‐led HF self‐care interventions on patient outcomes is scant.DesignA systematic review and meta‐analysis of randomised controlled trials (RCTs).Data SourcesSix databases (MEDLINE, Embase, Web of Science, CENTRAL, CINAHL and PsycINFO) were searched from the inception to December 2022 to identify eligible studies.MethodsRCTs published in English that evaluated the impact of nurse‐led HF self‐care interventions on quality of life, anxiety, symptom burden, sleep quality, healthcare service utilisation and mortality were included. The risk of bias in included studies was assessed using RoB 2.0. We conducted data syntheses using the R software and graded the quality of the evidence using the GRADE approach. The systematic review was conducted in accordance with the PRISMA.ResultsTwenty‐five studies with 2746 subjects were included. Our findings demonstrated, that compared to the controls, nurse‐led self‐care interventions improved QOL (SMD: .83, 95% CI: .50–1.15, moderate evidence), anxiety (MD: 1.39, 95% CI: .49–2.29, high evidence) and symptom burden (SMD: .81, 95% CI: .24–1.38, low evidence) in people with HF. No significant effects were found in all‐cause hospital readmission and all‐cause emergency department visit. Research evidence on sleep quality, cardiac‐related hospital readmission, cardiac‐related emergency department visit and all‐cause mortality remained unclear.ConclusionsOur review suggests that nurse‐led HF self‐care interventions have favourable effects on the QOL, anxiety and symptom burden. Further, well‐designed RCTs are warranted to address the gaps identified in this review.Relevance to Clinical PracticeThe results indicated that nurse‐led HF self‐care interventions could improve QOL, anxiety and symptom burden in people with HF. Nurse‐led self‐care intervention could be integrated into current HF management practices.

Nurse‐led self‐care interventions improve quality of life: A meta‐analysis with prediction intervals

“…However, we would like to point out some concerns regarding the high heterogeneity of QOL outcomes that warrant further discussion. The authors (Huang et al, 2024) found a large effect size for improvement in QOL with nurse-led interventions (standardised mean difference: 0.83), but noted considerable heterogeneity (I 2 = 84%).…”

“…Accordingly, we conducted a prediction interval analysis using the data reported in the original meta-analysis (Huang et al, 2024).…”

“…Although the average effect across studies was large, in some settings or populations, the effect may be absent or even slightly favour the control group. This is critical for clinical decision makers In summary, Huang et al (Huang et al, 2024) made a valuable contribution by synthesising evidence from nurse-led interventions for self-care in HF. The identified benefits for QOL, anxiety and symptom burden are important findings that support the greater role of nurses in HF care.…”