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What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure?: An Individual Patient Data Meta-analysis
Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Medical and Health Sciences and Department of Cardiothoracic Surgery, Linköping University, Linköping, Sweden.
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2016 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, no 11, 861-871 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2016. Vol. 22, no 11, 861-871 p.
Keyword [en]
Heart failure, individual patient data meta-analysis, self-management
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
URN: urn:nbn:se:hj:diva-34066DOI: 10.1016/j.cardfail.2016.06.422PubMedID: 27374838ScopusID: 2-s2.0-84994164408Local ID: HHJADULTISOAI: oai:DiVA.org:hj-34066DiVA: diva2:1048617
Available from: 2016-11-21 Created: 2016-11-21 Last updated: 2016-11-25Bibliographically approved

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Mårtensson, Jan
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