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Help me to help myself. Effectiveness of nurse-led educational interventions to patient's self-care in chronic heart failure. A systematic review and meta-analysis.

Session Moderated poster session - Arrhythmias, Frailty and Advanced Practice

Speaker Azzurra Massimi

Congress : EuroHeartCare 2019

  • Topic : cardiovascular nursing and allied professions
  • Sub-topic : Chronic Nursing Care
  • Session type : Moderated Posters
  • FP Number : 48

Authors : A Massimi (Rome,IT), C De Vito (Rome,IT), ML Rega (Rome,IT), P Villari (Rome,IT), G Damiani (Rome,IT)

Authors:
A Massimi1 , C De Vito1 , ML Rega2 , P Villari1 , G Damiani2 , 1Sapienza University of Rome - Rome - Italy , 2Università Cattolica del Sacro Cuore - Rome - Italy ,

Citation:

Introduction. Heart Failure (HF) is a pandemic chronic disease with a prevalence of approximately 1% to 3% in the general population. Moreover, it is the main cause of hospitalization for people over 65 also because of a poor management of the disease and of the high complication rates that result in increased healthcare costs, hospital overcrowding and poor health outcomes. Self-care plays a central role in the management of patients with HF with evidence of effectiveness in reducing re-hospitalization rates and mortality. Nurses are well versed in self-care support and must play a leading role in the administration of interventions based on patient education and activation.

Purpose.  To carry out a systematic review and meta-analysis to assess the efficacy of the nurse-led educational interventions Vs usual care in improving self-care skills of patients with chronic HF.

Methods. Most important biomedical databases were searched for Randomized Control Trials of nurse-led support interventions performed with any kind of communicative or educational exchange on patients over 18 years of age with a previous diagnosis of HF and included in self-management programs. Improvement of HF self-management skills (self-care level) assessed using different scales, was summarized by calculating the standardized mean difference (SMD) and 95% confidence intervals (CI) stratified for the length of the follow-up.

Results. Globally, 14 RCTs were included involving 2078 participants. The Scale used for self-care assessment were the HF Self-Care Behavior Scale (3) or its European version (5). The other studies employed the Self-Care of HF Index (4), the Self-management of HF Scale (1) and the Artinian's HF Self-care Behavior Scale (1). Ten studies showed the efficacy of the interventions at 3 months (short term) with a SMD of 0.78 (95% CI 0.38-1.18) in favor of the self-care education interventions. Five studies reported on self-care abilities at 6-9 months (medium term), with not statistically significant results SMD 0.35 (95% CI -0.11 to 0.81). The long-term effect of the educational interventions, assessed in three studies, showed no statistically significant improvement in self-care behaviors (SMD 0.05, IC95% -0.12 - 0.22).

Conclusions. The results of this meta-analysis show that nursing educational interventions improve self-care behaviors in HF, but mainly in the short term: to achieve good health results it is therefore necessary to implement strategies that strengthen self-care behaviors over time. In this context, intensive educational interventions led by nurses, associated with continuity of care and appropriate transition between hospital and intermediate care, can determine the best outcomes for patients with HF, ensuring the continuity over time of the short time effect.  This approach could have a major impact not only on individual patient, but on the general reduction of complications, hospitalization, medical costs and ultimately mortality.

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