title: What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis.
abstract: BACKGROUND
  To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations.
  
  
  RESULTS
  Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97-0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96-0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92-0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics.
  
  
  CONCLUSIONS
  No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.
authors.affiliation: Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: n.h.jonkman@vu.nl.
authors.forename: Nini H
authors.initials: NH
authors.lastname: Jonkman
authors.affiliation: Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Westland
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Rolf H H
authors.initials: RH
authors.lastname: Groenwold
authors.affiliation: Department of Medical and Health Sciences and Department of Cardiothoracic Surgery, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden.
authors.forename: Susanna
authors.initials: S
authors.lastname: Ågren
authors.affiliation: Department of Cardiology, Hospital Reina Sofia, Cordoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.affiliation: British Heart Foundation, Glasgow, UK.
authors.forename: Lynda
authors.initials: L
authors.lastname: Blue
authors.affiliation: Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Pieta W F
authors.initials: PW
authors.lastname: Bruggink-André de la Porte
authors.affiliation: Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.affiliation: Department of Health Services, University of Washington, Seattle, Washington.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.affiliation: Institute of Nursing Science, University of Basel, Basel, Switzerland.
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Leventhal
authors.affiliation: Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Dirk J A
authors.initials: DJ
authors.lastname: Lok
authors.affiliation: Department of Nursing Science, Jönköping University, Jönköping, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Mårtensson
authors.affiliation: Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.affiliation: Graduate School of Health Sciences, Hirosaki University, Aomori, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Otsu
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Peters-Klimm
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.affiliation: Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Strömberg
authors.affiliation: Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ross T
authors.initials: RT
authors.lastname: Tsuyuki
authors.affiliation: Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jaap C A
authors.initials: JC
authors.lastname: Trappenburg
authors.affiliation: Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D000073278:Self-Management / Q000379:methods*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
keywords: Heart failure; individual patient data meta-analysis; self-management