Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme

Smeulders, Esther S.T.F.; van Haastregt, Jolanda C.M.; Ambergen, Ton; Stoffers, Henri E.J.H.; Janssen-Boyne, Josiane J.J.; Uszko-Lencer, Nicole H.K.M.; Gorgels, Anton P.M.; Lodewijks-van der Bolt, Cara L.B.; van Eijk, Jacques Th.M.; Kempen, Gertrudis I.J.M.

doi:10.1016/j.pec.2010.01.003

« Previous Next »Patient Education and Counseling
Volume 81, Issue 2 , Pages 214-221, November 2010

Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme

Esther S.T.F. Smeulders
- Department of Health Care and Nursing Science, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
- Corresponding author at: Maastricht University/CAPHRI School for Public Health and Primary Care, Department of Health Care and Nursing Science, PO Box 616, Maastricht, 6200 MD, The Netherlands.
Jolanda C.M. van Haastregt
- Department of Health Care and Nursing Science, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
Ton Ambergen
- Department of Methodology and Statistics, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
Henri E.J.H. Stoffers
- Department of General Practice, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
Josiane J.J. Janssen-Boyne
- Department of Cardiology, Department of Integrated Care, University Hospital Maastricht, Maastricht, The Netherlands
Nicole H.K.M. Uszko-Lencer
- Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands
Anton P.M. Gorgels
- Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands
Cara L.B. Lodewijks-van der Bolt
- Department of Cardiology, Atrium Medical Centre, Heerlen, The Netherlands
Jacques Th.M. van Eijk
- Department of Social Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
Gertrudis I.J.M. Kempen
- Department of Health Care and Nursing Science, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
- Corresponding author at: Maastricht University/CAPHRI School for Public Health and Primary Care, Department of Health Care and Nursing Science, PO Box 616, Maastricht, 6200 MD, The Netherlands. Tel.: +31 43 388 2292; fax: +31 43 388 41 62.

Received 20 July 2009; received in revised form 30 December 2009; accepted 9 January 2010. published online 12 February 2010.

Abstract

Objective

The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n=317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life.

Methods

Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life.

Results

In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up.

Conclusion

Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme.

Practice implications

These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.

Keywords: Heart failure, Self-management, Quality of life, Nurse, Subgroup analyses, Differential effects