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From Department of Rehabilitation, Nursing Science and Sports (N.H.J., H.W., J.C.A.T., M.J.S.) and Julius Center for Health Sciences and Primary Care (R.H.H.G., A.W.H.), University Medical Center Utrecht, The Netherlands; Departments of Medical and Health Sciences and Department of Cardiothoracic Surgery (S.Å.), Department of Medical and Health Sciences, Division of Nursing Science (S.Å., A.S.), Department of Social and Welfare Studies (T.J.), and Department of Cardiology (A.S.), Linköping University, Sweden; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A.); British Heart Foundation, Glasgow, UK (L.B.); Department of Cardiology, Deventer Hospital, The Netherlands (P.W.F.B.-A.d.l.P., D.J.A.L.); Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (D.A.D.); Department of Health Services, University of Washington, Seattle (P.L.H.); Department of Internal Medicine, University of Michigan, Ann Arbor (M.H.); Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands (G.I.J.M.K.); Institute of Nursing Science, University of Basel, Switzerland (M.E.L.); Department of Nursing Science, Jönköping University, Sweden (J. Mårtensson); Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain (J. Muñiz); Graduate School of Health Sciences, Hirosaki University, Aomori, Japan (H.O.); Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany (F.P.-K.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (M.W.R.); School of Nursing, University of Pennsylvania, Philadelphia (B.R.); Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (R.T.T.); and Department of Cardiology, University Medical Center Groningen, The Netherlands (D.J.v.V.).
Published: March 2016
AI Article Synopsis
Article Abstract
Background: Self-management interventions are widely implemented in the care for patients with heart failure (HF). However, trials show inconsistent results, and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in patients with HF and whether subgroups of patients respond differently.
Methods And Results: A systematic literature search identified randomized trials of self-management interventions. Data from 20 studies, representing 5624 patients, were included and analyzed with the use of mixed-effects models and Cox proportional-hazard models, including interaction terms. Self-management interventions reduced the risk of time to the combined end point of HF-related hospitalization or all-cause death (hazard ratio, 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (hazard ratio, 0.80; 95% CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference, 0.15; 95% CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on the number of HF-related hospital days in patients <65 years of age (mean, 0.70 versus 5.35 days; interaction P=0.03). Patients without depression did not show an effect of self-management on survival (hazard ratio for all-cause mortality, 0.86; 95% CI, 0.69-1.06), whereas in patients with moderate/severe depression, self-management reduced survival (hazard ratio, 1.39; 95% CI, 1.06-1.83, interaction P=0.01).
Conclusions: This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death and HF-related hospitalization alone and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of patients with HF, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.
