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J Card Fail. 2016 Nov;22(11):861-871. doi: 10.1016/j.cardfail.2016.06.422. Epub 2016 Jun 30.

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

Author information

1
Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: n.h.jonkman@vu.nl.
2
Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Medical and Health Sciences and Department of Cardiothoracic Surgery, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden.
5
Department of Cardiology, Hospital Reina Sofia, Cordoba, Spain.
6
British Heart Foundation, Glasgow, UK.
7
Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
8
Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
9
Department of Health Services, University of Washington, Seattle, Washington.
10
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
11
Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
12
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
13
Institute of Nursing Science, University of Basel, Basel, Switzerland.
14
Department of Nursing Science, Jönköping University, Jönköping, Sweden.
15
Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
16
Graduate School of Health Sciences, Hirosaki University, Aomori, Japan.
17
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
18
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
19
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
20
Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden.
21
Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

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% confidence interval [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.

KEYWORDS:

Heart failure; individual patient data meta-analysis; self-management

PMID:
27374838
PMCID:
PMC5180428
DOI:
10.1016/j.cardfail.2016.06.422
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The authors declare the following interests: this work was supported by a grant from The Netherlands Organisation for Health Research and Development, ZonMw (grant number 520001002). DAD reports grants from NIH during the conduct of the study, outside the submitted work. MH reports grants from MDRTC during the conduct of the study, outside the submitted work. RTT reports investigator-initiated grants from Merck Canada Inc., AstraZeneca Canada, and personal fees from Merck Canada Inc., all outside the submitted work. The other authors declare no conflict of interest.

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