Abstract
The effectiveness of heart failure (HF) self-management interventions varies within patients suggesting that one size does not fit all. It is expected that effectiveness can be optimized when interventions are tailored to individual patients. The aim of this review was to synthesize the literature on current use of tailoring in self-management interventions and patient characteristics associated with self-management capacity and success of interventions, as building blocks for tailoring. Within available trials, the degree to which interventions are explicitly tailored is marginal and often limited to content. We found that certain patient characteristics that are associated with poor self-management capacity do not influence effectiveness of a given intervention (i.e., age, gender, ethnicity, disease severity, number of comorbidities) and that other characteristics (low: income, literacy, education, baseline self-management capacity) in fact are indicators of patients with a high likelihood for success. Increased scientific efforts are needed to continue unraveling success of self-management interventions and to validate the modifying impact of currently known patient characteristics.
Highlights
Heart failure (HF) is a major health problem [1, 2], characterized by a wide spectrum of debilitating symptoms, poor quality of life, frequent hospitalizations, and high mortality [3, 4]
When self-management was studied as part of more comprehensive disease-management or telehealth program, more robust results were reported, such as reduction of disease-related hospital admissions [18,19,20,21,22,23], mortality [18, 19, 22], and improved health-related quality of life (HRQoL) [24]
Conceptual framework of symptom management model developed by Dodd et al and coaching strategies a Variables used to assess patients and assign them to a tailored intervention component NYHA New York Heart Association, PCP primary care physician, TC telephone contact/consultation, FU follow-up, NR not reported could have resulted in individualization of the intervention, Patient Characteristics Associated With but this was not clearly reported in the publication
Summary
Heart failure (HF) is a major health problem [1, 2], characterized by a wide spectrum of debilitating symptoms, poor quality of life, frequent hospitalizations, and high mortality [3, 4]. When self-management was studied as part of more comprehensive disease-management or telehealth program, more robust results were reported, such as reduction of disease-related hospital admissions [18,19,20,21,22,23], mortality [18, 19, 22], and improved health-related quality of life (HRQoL) [24]. The results from the aforementioned reviews indicate that the evidence for effectiveness of self-management interventions is ambiguous This may be partly due to mixed quality of the reviews [26], heterogeneity in program and patient characteristics [27], and low treatment fidelity of the provider [28]. An important starting point is recognizing that managing a complex multiimpact disease is difficult This is supported by several studies showing that self-management capacity in patients with HF is generally poor [29,30,31,32]. In interventions with face-to-face consultations, interpersonal communication, goal setting, and problem solving
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