Do Self-Management Interventions Work in Patients With Heart Failure?

Nini H Jonkman, Heleen Westland, Rolf H H Groenwold, Susanna Ågren, Felipe Atienza, Lynda Blue, Pieta W F Bruggink-André de la Porte, Darren A DeWalt, Paul L Hebert, Michele Heisler, Tiny Jaarsma, Gertrudis I J M Kempen, Marcia E Leventhal, Dirk J A Lok, Jan Mårtensson, Javier Muñiz, Haruka Otsu, Frank Peters-Klimm, Michael W Rich, Barbara Riegel, Anna Strömberg, Ross T Tsuyuki, Dirk J van Veldhuisen, Jaap C A Trappenburg, Marieke J Schuurmans, Arno W Hoes

-Self-management interventions are widely implemented in care for patients with heart failure (HF). Trials however 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 HF patients and whether subgroups of patients respond differently. -Systematic literature search identified randomized trials of self-management interventions. Data of twenty studies, representing 5624 patients, were included and analyzed using mixed effects models and Cox proportional-hazard models including interaction terms. Self-management interventions reduced risk of time to the combined endpoint HF-related hospitalization or all-cause death (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (HR, 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 number of HF-related hospital days in patients <65 years (mean number of days 0.70 days vs. 5.35 days; interaction p=0.03). Patients without depression did not show an effect of self-management on survival (HR for all-cause mortality, 0.86; 95%CI, 0.69-1.06), while in patients with moderate/severe depression self-management reduced survival (HR, 1.39; 95%CI, 1.06-1.83, interaction p=0.01). -This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death, 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 HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.