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What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis
University of Medical Centre Utrecht, Netherlands.
University of Medical Centre Utrecht, Netherlands.
University of Medical Centre Utrecht, Netherlands.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
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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
Churchill Livingstone Inc. Medical Publishers , 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
Identifiers
URN: urn:nbn:se:liu:diva-133118DOI: 10.1016/j.cardfail.2016.06.422ISI: 000388059200004PubMedID: 27374838OAI: oai:DiVA.org:liu-133118DiVA: diva2:1055260
Note

Funding Agencies|Dutch Ministry of Health, Welfare and Sport, ZonMw [520001002]

Available from: 2016-12-12 Created: 2016-12-09 Last updated: 2016-12-19Bibliographically approved

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Ågren, SusannaJaarsma, TinyStrömberg, Anna
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Division of Nursing ScienceFaculty of Medicine and Health SciencesDepartment of Thoracic and Vascular SurgeryDivision of Nursing ScienceDepartment of Cardiology in Linköping
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Journal of Cardiac Failure
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CiteExportLink to record
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Citation style
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