Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: A systematic review

Abstract 

Objective

This review examined the effectiveness of self-management interventions compared to usual care on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure.

Methods

A systematic review was performed. MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched between 1996 and 2009. Randomized controlled trials were selected evaluating self-management interventions designed for patients with chronic heart failure. Outcomes of interest are mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life.

Results

Nineteen randomized controlled trials were identified. The effectiveness of heart failure management programs initiating self-management interventions in patients with chronic heart failure indicate a positive effect, although not always significant, on reduction of numbers of all-cause hospital readmitted patients and due to chronic heart failure, decrease in mortality and increasing quality of life.

Conclusion

This systematic review found that current available published studies show methodological shortcomings impairing validation of the effectiveness of self-management interventions on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure.

Practice implications

Further research should determine independent effects of self-management interventions and different combinations of interventions on clinical and patient reported outcomes.

Abbreviations: HF, heart failure, CHF, chronic heart failure, NYHA (1–4), New York Heart Failure classification, LVEF, Left Ventricular Ejection Fraction, QoL, quality of life, MLWHFQ, Minnesota Living With Heart Failure Questionnaire, SF-36/12, Short Form 36/12, 95%CI, 95% confidence interval, RR, relative risk, HR, hazard ratio, IQR, interquartile range, SD, standard deviation, RD, risk difference, NNT, number needed to treat, RRR, relative risk reduction, CABG, Coronary Artery Bypass Grafting, PTCA, percuntaneous coronary angioplasty, PCP, primary care physician, ACE-inhibitor, angiotensine converting enzym-inhibitor

Keywords: Self-management interventions, Chronic heart failure