Self-management on heart failure: A meta-analysis

Historical Gaps in the Integration of Patient-Centric Self-Management Components in HFrEF Interventions: An Umbrella Narrative Review

Background: Chronic disease self-management (CDSM) interventions have shown promise in improving patient outcomes in heart failure (HF), particularly for those with reduced ejection fraction (HFrEF). Patient-centric self-management programs often incorporate key components such as education, self-monitoring, and goal setting. However, the extent to which these components are consistently reported and integrated into studies remains unclear. This umbrella narrative review aims to analyze systematic reviews to assess the consistency of reporting on patient-centric self-management components implemented in trials and studies. Methods: This umbrella narrative review synthesized findings from systematic reviews and meta-analyses published between 2000 and 2023 for CDSM tools in HF. Eligible studies were assessed for the presence and consistency of reporting on education, self-monitoring, and goal setting in self-management interventions for HFrEF. Data extraction focused on the frequency of reporting these components and the gaps in reporting long-term patient outcomes. Results: Among the included systematic reviews, education was the most consistently reported component (100%), while self-monitoring and goal setting were each reported in around 50% of studies. Reporting of long-term outcomes, such as mortality and quality of life, was highly variable and often absent. These inconsistencies highlight significant gaps in the evidence base for CDSM interventions. Conclusions: This review identifies gaps in the consistent reporting of key CDSM components in systematic reviews of HFrEF interventions. The inconsistent inclusion of all three components together and limited reporting of long-term outcomes may hinder the development of a robust evidence base for the adoption of these tools in HF guidelines. Future studies should prioritize comprehensive reporting to strengthen the foundation for patient-centric self-management strategies in HF care. PROSPERO registration number CRD42023431539.

Understanding the Lived Experience of Patients With Heart Failure During the COVID-19 Pandemic: A Systematic Review and Meta-synthesis of Qualitative Studies

BACKGROUND

Patients with heart failure face multifaceted challenges, including emotional, social, and psychological burdens, while managing their condition. The COVID-19 pandemic exacerbated these difficulties, amplifying fear, uncertainty, and healthcare complexities, further complicating their experiences.

OBJECTIVE

The objective of this study was to identify and analyze the challenges faced by patients with heart failure during the pandemic.

METHODS

A systematic review and meta-synthesis were conducted to analyze data from qualitative studies. Data were sourced from EMBASE, PubMed, and SCOPUS, spanning from March 11, 2020, when the WHO declared COVID-19 a pandemic, to May 5, 2023, marking the end of COVID-19 as a global public health emergency.

RESULTS

A systematic review and meta-synthesis were conducted, identifying 676 articles through database searches: CINAHL-Complete (n = 130), PubMed (n = 313), SCOPUS (n = 210), hand search (n = 22), and Thai journal online (ThaiJO) (n = 1). After screening and quality assessment using the Critical Appraisal Skills Programme, 17 full-text articles of sufficient quality involving 277 participants with heart failure from East Asia (Taiwan, Japan), Southeast Asia (Thailand, Indonesia), Europe (Denmark, UK, Spain, Italy, Sweden), North America (United States), and the Middle East (Iran) were included in the synthesis. Six primary themes emerged: (1) Emotional Impact-patients reported increased anxiety, fear of disease progression, and heightened feelings of isolation, (2) Limited Physical and Social Activities-restrictions during the pandemic significantly disrupted daily routines, (3) Cultivating Resilience and Meaningful Living-many adapted by finding new coping mechanisms and purpose, (4) Divergent Perspectives on Care Delivery Innovation-although telehealth offered convenience for some, others faced challenges because of the lack of in-person care, (5) Social Support from Family and Friends-family support was critical but often limited by quarantine measures, and (6) Trust in Healthcare Providers-trust emerged as a key factor in managing heart failure during the crisis. Using the GRADE-CERQual approach, the certainty of evidence was evaluated and ranged from moderate to high.

CONCLUSIONS

The findings underscore the urgent need for targeted interventions that address the emotional and practical needs of patients with heart failure during crises. By promoting well-being and enhancing healthcare delivery, these insights can inform healthcare providers and policymakers in developing tailored support strategies aimed at improving patient outcomes and quality of lifePROSPERO registration number: CRD42024526561.

The long-term effect of an m-health tool on self-care in patients with heart failure: a pre-post interventional study with a mixed-method analysis

AIMS

The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool.

METHODS AND RESULTS

In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security.

CONCLUSION

The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed.

REGISTRATION

ClinicalTrials.gov: NCT04955600.

The effects of a 24-week interactive text message-based mobile health intervention for enhancing self-care behaviours of patients with heart failure: A quasi-experimental study

AIMS

The aim of this study was to identify the effects of a 24-week interactive text message-based mobile health intervention (called) on enhancing the self-care behaviours of patients with heart failure.

BACKGROUND

Whether text message-based mobile health intervention can be used to improve long-term adherence to self-care behaviours among heart failure patients remains unclear.

DESIGN

A quasi-experimental study with a pretest-post-test design and repeated measures.

METHODS

Data from 100 patients (mean age, 58.78 years; 83.0% men) were analysed. The intervention group (n = 50) used the program over 24 weeks, which consisted of weekly goal setting and interactive text messaging, while the control group (n = 50) received usual care. Trained research assistants collected data using self-reported Likert questionnaires. Primary (self-care behaviours) and secondary (health literacy, eHealth literacy, and disease knowledge) outcome variables were measured at baseline and at 1, 3 and 6 months after intervention for follow-up.

RESULTS

The findings showed that the intervention group demonstrated significantly better self-care behaviours than the control group during the 6 months. Notably, the trajectory of self-care behaviours of the patients in the intervention group showed a steep rise between the first- and third-month follow-up, followed by high stability between the third- and sixth-month follow-up. In addition, the intervention group had significantly higher disease knowledge than the control group at the first- and sixth-month follow-up.

CONCLUSIONS

We found that the program, as an interactive text messaging service, may be an optimal strategy for improving long-term adherence to self-care behaviours through motivating and providing social support.

RELEVANCE TO THE NURSING PRACTICE

The WithUs program can help nurses and other healthcare professionals to track patients' health indicators such as symptom severity, diet and physical activity. In addition, nurses can take an important role in evaluating the efficacy of the app in relation to patients' health outcome.

PATIENT OR PUBLIC CONTRIBUTION

Patients have completed a self-reported questionnaire after providing informed consent.

Patient’s knowledge, gender, and physical activity level as the predictors of self-care in heart failure patients

Introduction: Self-care management is the fundamental approach for Heart Failure (HF) management and is influenced by patient ability in preventing rehospitalization, mortality, and morbidity. Therefore, this study aims to investigate the predictors of a patient’s ability in HF self-care management. Design and Methods: A cross-sectional study was carried out on 96 patients with HF. The data were collected through interviews using questionnaires on demographic characteristics, physical activity (IPAQ), knowledge (Dutch Heart Failure Knowledge Score), and self-care management (Self Care Heart Failure Index). Subsequently, the data were analyzed using logistic regression analysis, and the best fit model for predicting self-care management in HF patients was generated. Results: The proportion of samples was 56.3% female, with mostly primary school (50%) as their education level. Furthermore, the proportion of patients with adequate HF self-care management was only 21% of the total participant. Based on the results, the patient’s physical activity level, HF knowledge, and gender were verified as a predictor of self-care management. Conclusions: The HF knowledge level, physical activity level, and gender were the predictors of HF self-care management.

Digital health and modern technologies applied in patients with heart failure: Can we support patients’ psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.

Frailty, Health Literacy, and Self-Care in Patients with Chronic Kidney Disease in Taiwan

Chronic kidney disease (CKD) is a chronic and often irreversible disease that requires active self-care to mitigate adverse outcomes. This study aimed to analyze the associations of demographic and disease data, frailty, health literacy (HL), and CKD self-care (CKDSC) in patients with CKD. We conducted a cross-sectional study at two hospitals in Taiwan. A total of 144 CKD patients with a mean age of 66.8 ± 9.1 years were included in the study. Among them, 79.2% were in CKD G3, and the mean time since diagnosis of CKD was 86 ± 48 months. Approximately 62.5% were identified as non-frail. The mean of HL and CKDSC were 11.76 ± 4.10 and 62.12 ± 9.31. In multivariate linear regression analysis, age ≥ 65 years (odds ratio (OR) = 5.67, 95% confidence interval (CI) 1.59–9.75), non-frailty (OR = 2.19, 95% CI 0.02–5.40), and high critical HL (OR = 1.43, 95% CI 0.13–2.90) showed significant positive correlation with CKDSC. Therefore, management of patients with CKD should focus on the young population, reinforcing health education strategies that improve critical HL and preventing frailty that may interfere with self-care. In addition, the patient’s social support resources should be expanded to achieve the goal of CKDSC.