Heart failure (HF) disease management programs have been tested, frequently via randomized controlled trials (RCTs), and reported in the literature. One of the interventions often included in disease management programs is self-care. Quality of life (QOL) is an individual outcome that may benefit from self-care interventions. Thus, the purposes of this review article are to (1) identify and critique research designed to test self-care interventions to improve QOL in HF patients, (2) identify gaps in the literature, and (3) provide recommendations for future research. A literature search was conducted for the time period of 1995 to 2007. The search terms were HF and QOL with self-care and self-management. Twenty-one articles that included HF self-care, self-management, or self-monitoring as an intervention with QOL as an outcome were identified. Seventeen of the studies were RCTs, and 4 of the studies used longitudinal, pre/post or repeated measures designs. Of the 17 RCTs, 9 studies demonstrated greater improvement in QOL in the intervention group as compared with the usual care group. Regarding the studies that used repeated measures designs, all 4 of the studies demonstrated greater improvement in QOL from baseline to follow-up. Findings from RCTs of self-care, as an intervention, on HF patient QOL do not allow one to draw strong conclusions about the benefits of this intervention on QOL outcomes. Several factors may have contributed to these equivocal findings (including methodological and conceptual issues). The future study of self-care and its effect on QOL outcomes in HF patients will benefit from multisite, large sample-size RCTs with self-care as the primary intervention, careful definition of terms, and use of conceptual frameworks. Thus, self-care strategies to improve HF patient QOL need to be further tested, and the most efficacious strategies can subsequently provide the basis for changing clinical practice and improving patients' lives.
Kathleen L. Grady, PhD, RN, APN, FAAN Administrative Director, Center for Heart Failure, Bluhm Cardiovascular Institute of Northwestern Memorial Hospital, and Associate Professor, Department of Surgery, Division of Cardiothoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Corresponding author Kathleen L. Grady, PhD, RN, APN, FAAN, Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery, 201 East Huron Street, Galter Pavilion 11-140, Chicago, IL 60611-3056 (firstname.lastname@example.org).