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Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme [with consumer summary]
Smeulders ESTF, van Haastregt JCM, Ambergen T, Stoffers HEJH, Janssen-Boyne JJJ, Uszko-Lencer NHKM, Gorgels APM, Lodewijks-van der Bolt CLB, van Eijk JTM, Kempen GIJM
Patient Education and Counseling 2010 Nov;81(2):214-221
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: The chronic disease self-management programme (CDSMP) was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life. METHODS: Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life. RESULTS: In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up. CONCLUSION: Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme. PRACTICE IMPLICATIONS: These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.
With permission from Excerpta Medica Inc.

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