Elsevier

Journal of Cardiac Failure

Volume 19, Issue 2, February 2013, Pages 125-134
Journal of Cardiac Failure

Review Article
Effect of Psychosocial Interventions on Quality of Life in Patients With Chronic Heart Failure: A Meta-analysis of Randomized Controlled Trials

https://doi.org/10.1016/j.cardfail.2012.12.004Get rights and content

Abstract

Background

Patients with chronic heart failure (CHF) usually experience poor quality of life (QoL). Psychosocial interventions tend to affect QoL in CHF. The aim of this study was to explore: 1) the effectiveness of psychosocial interventions on patients' QoL; 2) the magnitude of this effect; and 3) factors that appear to moderate the reported effect on QoL.

Methods and Results

Meta-analysis of the data of 1,074 intervention patients and 1,106 control patients from 16 randomized controlled trials (RCTs) that reported QoL measures in treatment and control groups before and after a psychosocial intervention. Subgroup analyses were conducted between: 1) face-to-face versus telephone interventions; 2) interventions that included only patients versus those that included patients and their caregivers; and 3) interventions conducted by a physician and a nurse only, versus those conducted by a multidisciplinary team. Psychosocial interventions improved QoL of CHF patients (standardized mean difference 0.46, confidence interval [CI] 0.19–0.72; P < .001). Face-to-face interventions showed greater QoL improvement compared with telephone interventions (χ2 = 5.73; df = 1; P < .02). Interventions that included caregivers did not appear to be significantly more effective (χ2 = 1.12; df = 1; P > .29). A trend was found for multidisciplinary team approaches being more effective compared with nonmultidisciplinary approaches (χ2 = 1.96; df = 1; P = .16).

Conclusions

A significant overall QoL improvement emerged after conducting psychosocial interventions with CHF patients. Interventions based on a face-to-face approach showed greater benefit for patients' QoL compared with telephone-based approaches. No significant advantage was found for interventions conducted by a multidisciplinary team compared with a physician and nurse approach, or for psychosocial interventions which included patients' caregivers compared with patient-only approaches.

Section snippets

Studies Selection

We used the Cochrane review technique to search the major databases (Embase, Pubmed, Psychinfo, and Medline), as well as the reference sections of the selected studies, to identify English-language peer-reviewed studies published from January 1995 to July 2011 that explore the effects of psychosocial interventions on QoL in patients with CHF compared with control patients, by using the keywords “chronic heart failure,” “quality of life,” “psychosocial intervention,” and their combinations. The

Included Studies

Our initial search was performed with the use of the specified keywords in Embase, Pubmed, Psychinfo, and Medline. Titles and abstracts were independently read by 2 of the authors, and the full text of relevant studies was obtained from the libraries of our institutions. A small number of studies were also added from the reference sections of selected studies, mainly from reviews and meta-analyses. Of the 506 studies identified through initial database searching, 346 were excluded after

Discussion

This meta-analysis constitutes further evidence that psychosocial interventions tend to improve the QoL of CHF patients. More specifically, 13 of the 16 studies that fulfilled the inclusion criteria in this meta-analysis showed that CHF patients in the psychologic intervention group reported higher levels of QoL. Earlier meta-analytic reviews of psychosocial interventions in CHF have been focused mainly on different primary end points and have reported psychosocial intervention effects on QoL

Disclosures

None.

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