Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis

Authors Frank Peters-Klimm, Filipe Atienza, Pieta Bruggink-André de la Porte, Rolf H.H. Groenwold, Nini H. Jonkman, Marcia E. Leventhal, Ross T. Tsuyuki, Michael W. Rich, Dirk J.A. Lok, Barbara Riegel, Dirk J. van Veldhuisen, Lynda Blue, Anna Strömberg, Jan Mårtensson, Haruka Otsu, Javier Muñiz, Michele Heisler, Tiny Jaarsma, Heleen Westland, Marieke J. Schuurmans, Jaap C.A. Trappenburg, Arno W. Hoes, Paul L. Hebert, Gertrudis I.J.M. Kempen, Darren A. DeWalt, Susanna Ågren
Published in Circulation
Publication date 22 March 2016
Type Article


Background—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. Methods and Results—Systematic literature search identified randomized trials of selfmanagement 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 all-0.71- in Conclusions—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 selfmanagement interventions to subgroups of HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.

Language English
Published in Circulation
Year and volume 133 12
Page range 1189-1198