What are Effective Program Characteristics of Self-Management Interventions in Patients with Heart Failure? An Individual Patient Data Meta-Analysis

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School of Nursing Departmental Papers
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heart failure
individual patient meta-analysis
self-management
Cardiology
Cardiovascular Diseases
Circulatory and Respiratory Physiology
Medical Humanities
Medicine and Health Sciences
Nursing
Preventive Medicine
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Jonkman, Nini H
Westland, Heleen
Groenwold, Rolf H.H
Âgren, Susanna
Anguita, Manuel
Blue, Lynda
Bruggink-André de la Porte, Pieta W.F
DeWalt, Darren A
Hebert, Paul L
Heisler, Michele
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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.

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2016-11-01
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Journal of Cardiac Failure
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