Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme

Esther S. T. F. Smeulders*, Jolanda C. M. van Haastregt, Ton Ambergen, Henri E. J. H. Jelle Stoffers, Josiane J. J. Janssen-Boyne, Nicole H. K. M. Uszko-Lencer, Anton P. M. Gorgels, Cara L. B. Lodewijks-van der Bolt, Jacques Th. M. van Eijk, Gertrudis I. J. M. Kempen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life. Methods: Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life. Results: In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up. Conclusion: Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme. Practice implications: These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.
Original languageEnglish
Pages (from-to)214-221
JournalPatient Education and Counseling
Issue number2
Publication statusPublished - Nov 2010


  • Heart failure
  • Self-management
  • Quality of life
  • Nurse
  • Subgroup analyses
  • Differential effects

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