Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis

被引：225

作者：

Jonkman, Nini H. ^{[1
]}

Westland, Heleen ^{[1
]}

Groenwold, Rolf H. H. ^{[2
]}

Agren, Susanna ^{[3
,4
,5
,6
]}

Atienza, Felipe ^{[9
]}

Blue, Lynda ^{[10
]}

de la Porte, Pieta W. F. Bruggink-Andre ^{[11
]}

DeWalt, Darren A. ^{[12
]}

Hebert, Paul L.

Heisler, Michele ^{[13
]}

Jaarsma, Tiny ^{[7
]}

Kempen, Gertrudis I. J. M. ^{[14
]}

Leventhal, Marcia E. ^{[15
]}

Lok, Dirk J. A. ^{[11
]}

Martensson, Jan ^{[16
]}

Muniz, Javier ^{[17
,18
]}

Otsu, Haruka ^{[19
]}

Peters-Klimm, Frank ^{[20
]}

Rich, Michael W. ^{[21
]}

Riegel, Barbara ^{[22
]}

Stroemberg, Anna ^{[6
,8
]}

Tsuyuki, Ross T. ^{[23
]}

van Veldhuisen, Dirk J. ^{[24
]}

Trappenburg, Jaap C. A. ^{[1
]}

Schuurmans, Marieke J. ^{[1
]}

Hoes, Arno W. ^{[2
]}

机构：

[1] Univ Med Ctr Utrecht, Dept Rehabil Nursing Sci & Sports, Heidelberglaan 100, NL-3508 GA Utrecht, Netherlands

[2] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Heidelberglaan 100, NL-3508 GA Utrecht, Netherlands

[3] Linkoping Univ, Dept Med Sci, S-58183 Linkoping, Sweden

[4] Linkoping Univ, Dept Hlth Sci, S-58183 Linkoping, Sweden

[5] Linkoping Univ, Dept Cardiothorac Surg, S-58183 Linkoping, Sweden

[6] Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, S-58183 Linkoping, Sweden

[7] Linkoping Univ, Dept Social & Welf Studies, S-58183 Linkoping, Sweden

[8] Linkoping Univ, Dept Cardiol, S-58183 Linkoping, Sweden

[9] Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Madrid, Spain

[10] British Heart Fdn, Glasgow, Lanark, Scotland

[11] Deventer Hosp, Dept Cardiol, Deventer, Netherlands

[12] Univ N Carolina, Div Gen Med & Clin Epidemiol, Chapel Hill, NC USA

[13] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA

[14] Maastricht Univ, Dept Hlth Serv Res, CAPHRI Sch Publ Hlth & Primary Care, NL-6200 MD Maastricht, Netherlands

[15] Univ Basel, Inst Nursing Sci, CH-4003 Basel, Switzerland

[16] Jonkoping Univ, Dept Nursing Sci, Jonkoping, Sweden

[17] Univ A Coruna, Inst Univ Ciencias Salud, La Coruna, Spain

[18] INIBIC, La Coruna, Spain

[19] Hirosaki Univ, Grad Sch Hlth Sci, Aomori, Japan

[20] Univ Heidelberg Hosp, Dept Gen Practice & Hlth Serv Res, Heidelberg, Germany

[21] Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA

[22] Univ Penn, Sch Nursing, Philadelphia, PA 19104 USA

[23] Univ Alberta, Div Cardiol, Fac Med & Dent, Edmonton, AB, Canada

[24] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, NL-3508 GA Utrecht, Netherlands

来源：

CIRCULATION | 2016年 / 133卷 / 12期

关键词：

meta-analysis; self care; heart failure; RANDOMIZED CONTROLLED-TRIAL; LONG-TERM OUTCOMES; FORM HEALTH SURVEY; QUALITY-OF-LIFE; CARE; PROGRAM; EDUCATION; SUPPORT; BEHAVIOR;

D O I：

10.1161/CIRCULATIONAHA.115.018006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background- Self-management interventions are widely implemented in the care for patients with heart failure (HF). However, trials show inconsistent results, and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in patients with HF and whether subgroups of patients respond differently. Methods and Results- A systematic literature search identified randomized trials of self-management interventions. Data from 20 studies, representing 5624 patients, were included and analyzed with the use of mixed-effects models and Cox proportional-hazard models, including interaction terms. Self-management interventions reduced the risk of time to the combined end point of HF-related hospitalization or all-cause death (hazard ratio, 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (hazard ratio, 0.80; 95% CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference, 0.15; 95% CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on the number of HF-related hospital days in patients < 65 years of age (mean, 0.70 versus 5.35 days; interaction P=0.03). Patients without depression did not show an effect of self-management on survival (hazard ratio for all-cause mortality, 0.86; 95% CI, 0.69-1.06), whereas in patients with moderate/severe depression, self-management reduced survival (hazard ratio, 1.39; 95% CI, 1.06-1.83, interaction P=0.01). Conclusions- This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death and HF-related hospitalization alone and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of patients with HF, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.

引用

页码：1189 / 1198

页数：10

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