Does nurse-led interventions improve self-care behaviors among patients with heart failure? Results of a systematic review and meta-analysis

Background Heart failure is the most common cause of hospitalization for adults over the age of 65 years. The World Health Organization Report on therapeutic patient education recognizes the importance of patient centered education in the effective management of chronic diseases. It has been recognized that adoption of self-management skills by persons with chronic diseases is necessary to enable them to manage their condition. This meta-analysis evaluates the effectiveness of the nurse-led self-management interventions to improve self-care behaviors among patients. Methods Relevant major electronic databases were searched from inception to February 2014. All randomized controlled trials (RCTs) that compared nurse led self-management education with routine treatment were included in the systematic review. For meta-analyses of continuous data, standardized mean difference (SMD), along with 95% confidence interval (CI), was calculated because the same underlying concept was measured using different outcome measurements. Results Seven studies were included in the meta-analysis for a total of 942 participants, 493 (52.3%) of which were in the intervention group. Four studies involving 406 participants assessed the self-care abilities at 3 months (short term). The SMD was 0.64 (95%CI 0.19–1.10) in favor of the self-management education intervention. Four studies with a total of 707 participants reported on self-care abilities at 6-9 months (intermediate term) while the long-term effect of the educational intervention was assessed by two studies, with not statistically significant results in both cases (SMD 0.45; 95%CI -0.12–1.02 and SMD 0.06; 95%CI -0.15–0.26, respectively). Conclusions Supportive nursing educational interventions improve the selfcare behavior in patients with heart failure but only in the short period. Educational interventions should be reconsidered in a perspective of continuity of care. For this reason an effective discharge planning is crucial to guarantee continuity in an intermediate care framework. Key message Promoting self-care in chronic patients is necessary to enable them to manage their condition