TY - JOUR
T1 - What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis
AU - Jonkman, Nini H.
AU - Westland, Heleen
AU - Groenwold, Rolf H. H.
AU - Agren, Susanna
AU - Anguita, Manuel
AU - Blue, Lynda
AU - de la Porte, Pieta W. F. Bruggink-Andre
AU - Dewalt, Darren A.
AU - Hebert, Paul L.
AU - Heisler, Michele
AU - Jaarsma, Tiny
AU - Kempen, Gertrudis I.J.M.
AU - Leventhal, Marcia E.
AU - Lok, Dirk J. A.
AU - Martensson, Jan
AU - Muniz, Javier
AU - Otsu, Haruka
AU - Peters-Klimm, Frank
AU - Rich, Michael W.
AU - Riegel, Barbara
AU - Stroemberg, Anna
AU - Tsuyuki, Ross T.
AU - Trappenburg, Jaap C. A.
AU - Schuurmans, Marieke J.
AU - Hoes, Arno W.
PY - 2016/11
Y1 - 2016/11
N2 - 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.
AB - 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.
KW - Heart failure
KW - individual patient data meta-analysis
KW - self-management
U2 - 10.1016/j.cardfail.2016.06.422
DO - 10.1016/j.cardfail.2016.06.422
M3 - Article
VL - 22
SP - 861
EP - 871
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
SN - 1071-9164
IS - 11
ER -