A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes.
Harleah G Buck, Anna Stromberg, Misook L Chung and 6 others
PMID 29128777WHAT IT FOUND
Heart failure self-care programmes that involved both patients and informal carers gave mixed results.
Benefits often faded over time, and the review could not recommend specific components.
Key findings
01The review included 12 complete intervention studies involving 1459 dyads.
02Only one main outcome paper reported null findings on all outcomes, while five papers reporting secondary or later outcomes found null results.
03Interventions contained two to six components, and differences in components, delivery modes, and time allocation made it hard to attribute outcomes to any component.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 12 complete studies were analyzed, and the review included 18 papers because some studies had multiple outcome papers. Meta-analysis was not possible because the studies were few and heterogeneous. Interventions varied in components, delivery mode, number of sessions, and session length, so dose could not be compared. Several papers did not report enough detail about the intervention or follow-up, limiting replication. All studies were judged low to moderate quality, with limitations in blinding, allocation, and effect sizes. Effects were mixed, and secondary or later outcome papers often found null results. Search was limited to English, so non-English studies may have been missed. Eight ongoing papers were identified but could not be analyzed for components, contexts, or outcomes.
The easy way to misread this
Do not conclude that dyadic heart failure self-care education improves patient or carer outcomes. The review found mixed effects, several later outcome papers were null, and the interventions were too heterogeneous to identify an active component.