The effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions: a systematic review

Abstract

Review objectives The objective of this review is to synthesize the best available evidence regarding the effectiveness of patient centered self-care education for adult patients with heart failure relating to heart failure knowledge, self-care behaviors centered on heart failure, heart failure-related quality of life, and heart failure readmissions within one year of an index hospitalization. A secondary objective of this review is to determine the most effective education approach for interventions included in the review to deliver patient-centered self-care education to adult patients with heart failure.  Inclusion criteria Types of participants This review will consider studies that include all adult patients, 18 years and older, of any race, ethnicity, or gender with a diagnosis of HF regardless of etiology, severity, duration of HF, or presence of comorbid conditions. Type of intervention This review will consider all types of patient-centered, self-care education interventions for adult patients with HF provided by any health care provider, regardless of frequency, duration and intensity. For this review, patient-centered, self-care education interventions are defined as interventions designed towards the patient as a unique individual, taking into consideration a patient’s individual needs, preferences and values. The patient is the central focus of the planned intervention with a goal of meeting patient specific self-care educational goals and desired outcomes. Comparator intervention This review will consider as comparators standard care or non-patient-centered education programs such as written or video taped education materials that have not been individualized to a patient’s specific needs, preferences or values. Types of outcomes This review will consider studies that include the following outcomes as measured by valid and reliable instruments within one year post-intervention:  Heart failure knowledge such as knowledge related to the general pathophysiology of HF, treatment strategies, and signs/symptoms of HF as measured by valid and reliable instruments such as the Atlanta Heart Failure Knowledge Test (A-HFKT). Heart failure self-care behaviors including, but not limited to, HF management, symptom monitoring, and implementation of treatment strategies as measured by valid and reliable instruments such as the Self-Care Heart Failure Index (SCHFI) or the European Heart Failure Self-Care Behavior Scale (EHFScBS). Heart failure-related quality of life related to areas such as maintaining physical activity and exercise, symptom burden, self-efficacy, and maintaining social interaction and support, as measured by valid and reliable instruments such as the generic Short Form 36 (SF-36), or HF specific instruments such as the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or the Kansas City Cardiomyopathy Questionnaire (KCCQ). Heart failure admissions or readmissions within 1 year post intervention. For this review, hospital readmission is the consecutive admission to the same hospital, a different hospital, or another acute care facility related to a specific condition for which treatment was rendered on a previous hospitalization.