Heart failure self-care interventions to reduce clinical events and symptom burden

Background: Lack of adherence to prescribed therapies and poor symptom recognition are common reasons for recurring hospitalizations among heart failure (HF) patients. The purpose of this literature review is to examine the effectiveness of HF self-care interventions in relation to clinical events and symptom burden. Methods: A systematic review of randomized controlled trials with a HF self-care measure was conducted. The PubMed, CINAHL, and Medline databases were searched between 2010 and 2014, using the keyword "heart failure" in combination with the terms "self-care", "self-management", "self-care maintenance", "self-care confidence", "symptoms", and "hospitalizations". Outcomes of interest were clinical events and/or symptom burden. Results: Nine studies met the inclusion criteria. HF education was the core of all interventions examined. Dose and strategies varied across studies. All interventions that effectively decreased clinical events included education on how to respond to worsening HF symptoms. Conclusion: Knowledge alone does not improve HF self-care behaviors or reduce the risk of clinical events and/or symptom burden. Interventions that augment self-confidence or self-efficacy to perform optimal self-care management and self-care maintenance may be useful. Keywords: heart failure, self-care, self-management, self-care maintenance, self-care confidence, symptoms, hospitalizations