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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.
SUBMITTER: Jonkman NH
PROVIDER: S-EPMC5180428 | biostudies-literature | 2016 Nov
REPOSITORIES: biostudies-literature
Jonkman Nini H NH Westland Heleen H Groenwold Rolf H H RH Ågren Susanna S Anguita Manuel M Blue Lynda L Bruggink-André de la Porte Pieta W F PW DeWalt Darren A DA Hebert Paul L PL Heisler Michele M Jaarsma Tiny T Kempen Gertrudis I J M GI Leventhal Marcia E ME Lok Dirk J A DJ Mårtensson Jan J Muñiz Javier J Otsu Haruka H Peters-Klimm Frank F Rich Michael W MW Riegel Barbara B Strömberg Anna A Tsuyuki Ross T RT Trappenburg Jaap C A JC Schuurmans Marieke J MJ Hoes Arno W AW
Journal of cardiac failure 20160630 11
<h4>Background</h4>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.<h4>Methods and results</h4>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 ...[more]