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Educational Interventions for Patients With Heart Failure: A Systematic Review of Randomized Controlled Trials

Boyde, Mary BN, MN, MEd, RN, MRCNA; Turner, Catherine BA, GradDipEd, MN, PhD, RN; Thompson, David R. BSc, MA, PhD, RN, FRCN, FAAN, FESC; Stewart, Simon BA, PhD, RN, NFESC, FAHA, FCSANZ

Journal of Cardiovascular Nursing:
doi: 10.1097/JCN.0b013e3181ee5fb2
Articles: Online Only
Abstract

Background: Patient education is an important intervention for the management of heart failure; however, in practice patient education varies considerably.

Aim: To systematically review educational interventions that have been implemented for heart failure patients and assess their effectiveness.

Methods: Randomized controlled trials from 1998 to 2008 in CINAHL, MEDLINE, PsychInfo, EMBASE, and Cochrane were reviewed using the following search terms: patient education, education, educational intervention, self-care in combination with heart failure. There were 1515 abstracts reviewed independently by 2 reviewers.

Results: A total of 2686 patients were included in the 19 studies that met the inclusion criteria. Commonly, the initial educational intervention was a one-on-one didactic session conducted by nurses supplemented by written materials and multimedia approaches. Seven studies referred to a theoretical model as a framework for their educational intervention. Studies used a variety of outcome measures to evaluate their effectiveness. Of the studies reviewed, 15 demonstrated a significant effect from their intervention in at least one of their outcome measures.

Conclusion: All we hope from patient education has not yet been realized. Despite improvements in knowledge, we have variable results in outcomes, and this is very likely related to the heterogeneity of the studies included in this review. It was difficult to establish the most effective educational strategy as the educational interventions varied considerably in delivery methods and duration as well as the outcome measures that were used for the evaluation. A patient-centered approach to education based on educational theory and evaluated appropriately may assist to develop an evidence base for patient education.

In Brief

Background: Patient education is an important intervention for the management of heart failure; however, in practice patient education varies considerably. Aim: To systematically review educational interventions that have been implemented for heart failure patients and assess their effectiveness. Methods: Randomized controlled trials from 1998 to 2008 in CINAHL, MEDLINE, PsychInfo, EMBASE, and Cochrane were reviewed using the following search terms: patient education, education, educational intervention, self-care in combination with heart failure. There were 1515 abstracts reviewed independently by 2 reviewers. Results: A total of 2686 patients were included in the 19 studies that met the inclusion criteria. Commonly, the initial educational intervention was a one-on-one didactic session conducted by nurses supplemented by written materials and multimedia approaches. Seven studies referred to a theoretical model as a framework for their educational intervention. Studies used a variety of outcome measures to evaluate their effectiveness. Of the studies reviewed, 15 demonstrated a significant effect from their intervention in at least one of their outcome measures. Conclusion: All we hope from patient education has not yet been realized. Despite improvements in knowledge, we have variable results in outcomes, and this is very likely related to the heterogeneity of the studies included in this review. It was difficult to establish the most effective educational strategy as the educational interventions varied considerably in delivery methods and duration as well as the outcome measures that were used for the evaluation. A patient-centered approach to education based on educational theory and evaluated appropriately may assist to develop an evidence base for patient education.

Author Information

Mary Boyde, BN, MN, MEd, RN, MRCNA Cardiology Nurse Researcher/Adjunct Associate Lecturer, Cardiology Department, Princess Alexandra Hospital/The University of Queensland, Brisbane, Queensland, Australia.

Catherine Turner, BA, GradDipEd, MN, PhD, RN Professor and Head of School, School of Nursing and Midwifery, The University of Queensland, Brisbane, Queensland, Australia.

David R. Thompson, BSc, MA, PhD, RN, FRCN, FAAN, FESC Professor of Nursing, Cardiovascular Research Centre, Australian Catholic University, Melbourne, Victoria, Australia.

Simon Stewart, BA, PhD, RN, NFESC, FAHA, FCSANZ Professor, Head, Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.

Author contributions: M.B., C.T., D.R.T., S.S. (study design); M.B., C.T. (review of papers); M.B., C.T., D.R.T., S.S. (manuscript preparation and review).

SS is supported by the National Health and Medical Research Council of Australia.

Correspondence Mary Boyde, BN, MN, MEd, RN, MRCNA, Cardiology Department, Third Floor, Building One, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Brisbane, Queensland, 4102, Australia (m.boyde@uq.edu.au).

© 2011 Lippincott Williams & Wilkins, Inc.