Are self-management interventions effective in reducing hospital readmissions in patients with heart failure? Results of a systematic review and meta-analysis

Background All patients with chronic illness make decisions and engage in behaviours that affect their health (self-management). Disease control and outcomes depend to a significant degree on the effectiveness of self-management. The objective of this meta-analysis is to determine the effectiveness of self-management interventions on hospital readmission rates and health-related quality of life in patients with heart failure. Methods A computerized search of Pubmed, EMBASE, Scopus, the Cochrane Central Trials Registry and the Cochrane Database of Systematic Reviews was conducted until February 2013 to find Randomized Control Trials of self-management interventions that enrolled patients 18 years of age or older with diagnosed heart failure. The primary outcome of interest was all-cause hospital readmission, the secondary outcomes were compliance with treatment and quality of life score. For the included studies, we computed the pooled odds ratios (OR), the 95% confidence interval and the P value for all-cause hospital readmission. The pooled effects on health-related quality of life was not computable because of the differences in behavioural scales used in the studies. Results Overall, eight Randomized Control Trials with 1022 patients were included in the review. A meta-analysis based on six studies showed that self-management interventions significantly decreased hospital readmissions for all causes (OR 0.60; 95% CI 0.44-0.80). No significant effect on health-related quality of life was found in all but two of the five studies that evaluated this outcome. Conclusions Self-management programs targeted for patients with heart failure are effective in decreasing all-causes hospital readmissions and to a lesser extent in improving quality of life. Results from single studies seem to indicate that interventions with structured follow-up or nurse-led education are more effective than the others in improving health outcomes of patients with heart failure. Key messages Self-management programs targeted for patients with heart failure are effective in decreasing all-causes hospital readmissions. Interventions with structured follow-up or nurse-led education are more effective than the others.