What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis

Abstract

Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional-hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95%CI 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95%CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95%CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.

Self‐management support in routine primary care by nurses

“…Although self‐management interventions have been shown to positively affect health outcomes and cost‐effectiveness, current evidence for its effectiveness remains inconclusive due to methodological issues, such as intervention components, follow‐up time, outcome measurements, scarcely reported and measured treatment fidelity, and the heterogeneity in included subgroups of patients (Jonkman, Westland, Groenwold, et al ., ; Jonkman, Westland, Trappenburg, et al ., ). Given nurses’ current limited and inconsistent use of (effective) BCTs, questions arise regarding whether nurses’ role in providing self‐management support might affect the treatment fidelity of self‐management interventions.…”

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

“…In spite of differences in content, duration and personnel involved in care, a number of self‐management interventions has demonstrated some benefits in reducing HF‐related hospitalization and death . The mechanisms by which self‐care and disease management programmes are effective, and the common components of the most successful interventions have also been addressed.…”

A complex intervention of self‐management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities; A longitudinal follow‐up

“…Traditionally, patients receive individually information about disease management from healthcare professionals (Jonkman, Westland, Groenwold, et al., ; Jonkman, Westland, Trappenburg, et al., ; Lundh, Rosenhall, & Tornkvist, ; Zakrisson & Hagglund, ). However, even if patients are able to memorize that information, they will not automatically integrate it into their lives to create behaviour changes (Piredda, ; Stamler, ).…”

“…Systematic reviews described improvements in HRQoL of self‐management interventions in patients with COPD and CHF. They showed a beneficial effect on time to hospitalization, all‐cause death (Jolly et al., ; Jonkman, Schuurmans, Groenwold, Hoes, & Trappenburg, ; Jonkman, Westland, Groenwold, et al., ), symptom burden, physical exertion, and behavioural risk factors in self‐efficacy (Cannon et al., ; Ulin, Malm, & Nygardh, ), especially when disease education is provided (Cannon et al., ). However, the above studies described improvement of health after participating in self‐management interventions in separate diagnosis groups.…”