Abstract
Poor self-care behaviors can lead to an increase in the risk of adverse health outcomes among patients with heart failure. Although a number of studies have investigated the effectiveness of nurse-led self-care education, the evidence regarding the effects of nurse-led intervention in heart failure remains uncertain. This study aimed to evaluate evidence on the effectiveness of nurse-led heart failure self-care education on health outcomes in patients with heart failure. To identify studies testing nurse-led education designed to improve self-care among heart failure patients, comprehensive search methods were used between January 2000 and October 2019 to systematically search six electronic databases: PubMed, CINAHL, Embase, Cochrane library, Web of Science, and SCOPUS. All the eligible study data elements were independently assessed and analyzed using random-effects meta-analysis methods. Of 612 studies, eight articles were eligible for this study. Nurse-led heart failure self-care education significantly reduced the risk of all-cause readmission (risk ratio (RR) = 0.75, 95% confidence interval (CI) = 0.66–0.85), heart failure specific readmission (RR = 0.60, 95% CI = 0.42–0.85), and all-cause mortality or readmission (RR = 0.71, 95% CI = 0.61–0.82). However, nurse-led heart failure self-care education was not associated with improvements in the quality of life and heart failure knowledge. Studies on the effectiveness of nurse-led heart failure self-care education mostly report only the positive effects on patients’ health outcomes, whereas evidence of the effectiveness of the nurse-led approach is still limited. Therefore, high quality randomized controlled trials with detailed and explicit descriptions on the components of the interventions are needed.
Highlights
Heart failure is a major public health concern that affects around 26 million people worldwide [1,2,3].It has a high prevalence among older adults
Considering that this review mainly focused on heart failure specific readmission rate as its main outcome [18], more evidence is required on the effects of nurse-led heart failure self-care education on comprehensive, patient-centered health outcomes, such as patient-reported quality of life or knowledge on heart failure
We used the guideline for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [19] and devised research questions using the PICO format for systematic review [20]: for heart failure patients (Participants), is hospital-based, nurse-led heart failure self-care education (Intervention) more beneficial to the health outcomes (Outcomes) for intervention group than the control group (Comparison) in randomized controlled trials (RCTs) (Type of studies)? Before undertaking this systematic review, we checked whether there are already existing or ongoing reviews in the Cochrane library Joanna
Summary
Heart failure is a major public health concern that affects around 26 million people worldwide [1,2,3]. It has a high prevalence among older adults. Patients aged 65 years or older have been reported to account for 80% and 90% of heart failure-related hospitalizations and deaths, respectively [4]. Despite advances in early diagnosis and treatment of heart failure, its progressive and debilitating characteristics [5] result in substantial morbidity and a high burden of long-term management, which negatively affects patients, families, and health systems [1,4,6]. Health-related quality of life, a major outcome indicator of chronic health conditions, is known to be much worse in people with heart failure than those with other chronic
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