Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme
Received 20 July 2009; received in revised form 30 December 2009; accepted 9 January 2010. published online 12 February 2010. Corrected Proof
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.
aDepartment of Health Care and Nursing Science, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
bDepartment of Methodology and Statistics, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
cDepartment of General Practice, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
dDepartment of Cardiology, Department of Integrated Care, University Hospital Maastricht, Maastricht, The Netherlands
eDepartment of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands
fDepartment of Cardiology, Atrium Medical Centre, Heerlen, The Netherlands
gDepartment of Social Medicine, 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.
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.
ABSTRACT
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