Department of Stomatology, First Hospital of Shanxi Medical University, Taiyuan, China.
Department of Nursing, First Hospital of Shanxi Medical University, Taiyuan, China.
Int Nurs Rev. 2024 Mar;71(1):180-188. doi: 10.1111/inr.12852. Epub 2023 Jun 19.
To perform a meta-analysis of randomized controlled trials to investigate the effect of nurse-led education on death, readmission, and quality of life in patients with heart failure.
The evidence of the effectiveness of nurse-led education in heart failure patients from randomized controlled trials is limited, and the results are inconsistent. Therefore, the impact of nurse-led education remains poorly understood, and more rigorous studies are needed.
Heart failure is a syndrome associated with high morbidity, mortality, and hospital readmission. Authorities advocate nurse-led education to raise awareness of disease progression and treatment planning, as this could improve patients' prognosis.
PubMed, Embase, and the Cochrane Library were searched up to May 2022 to retrieve relevant studies. The primary outcomes were readmission rate (all-cause or HF-related) and all-cause mortality. The secondary outcome was quality of life, evaluated by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), EuroQol-5D (EQ-5D), and visual analog scale for quality of life.
Although there was no significant association between the nursing intervention and all-cause readmissions [RR (95% CI) = 0.91 (0.79, 1.06), P = 0.231], the nursing intervention decreased HF-related readmission by 25% [RR (95% CI) = 0.75 (0.58, 0.99), P = 0.039]. The e nursing intervention reduced all-cause readmission or mortality as a composite endpoint by 13% [RR (95% CI) = 0.87 (0.76, 0.99), P = 0.029]. In the subgroup analysis, we found that home nursing visits reduced HF-related readmissions [RR (95% CI) = 0.56 (0.37, 0.84), P = 0.005]. In addition, the nursing intervention improved the quality of life in MLHFQ and EQ-5D [standardized mean differences (SMD) (95% CI) = 3.38 (1.10, 5.66), 7.12 (2.54, 11.71), respectively].
The outcome variation between studies may be due to reporting methods, comorbidities, and medication management education. Patient outcomes and quality of life may also vary between different educational approaches. Limitations of this meta-analysis stem from the incomplete reporting of information from the original studies, the small sample size, and the inclusion of English language literature only.
Nurse-led education programs significantly impact HF-related readmission rates, all-cause readmission, and mortality rates in patients with HF.
The results suggest stakeholders should allocate resources to develop nurse-led education programs for HF patients.
对随机对照试验进行荟萃分析，以调查护士主导的教育对心力衰竭患者死亡、再入院和生活质量的影响。
来自随机对照试验的护士主导教育对心力衰竭患者有效性的证据有限，且结果不一致。因此，护士主导教育的影响仍不清楚，需要进行更严格的研究。
心力衰竭是一种与高发病率、高死亡率和高医院再入院率相关的综合征。权威机构提倡护士主导的教育，以提高对疾病进展和治疗计划的认识，因为这可以改善患者的预后。
检索 PubMed、Embase 和 Cochrane Library 至 2022 年 5 月，以检索相关研究。主要结局是再入院率（全因或 HF 相关）和全因死亡率。次要结局是生活质量，用明尼苏达州心力衰竭生活质量问卷（MLHFQ）、欧洲五维健康量表（EQ-5D）和生活质量视觉模拟量表评估。
尽管护理干预与全因再入院之间没有显著关联[RR（95%CI）=0.91（0.79, 1.06），P=0.231]，但护理干预可使 HF 相关再入院率降低 25%[RR（95%CI）=0.75（0.58, 0.99），P=0.039]。护理干预使全因再入院或死亡率作为复合终点降低 13%[RR（95%CI）=0.87（0.76, 0.99），P=0.029]。在亚组分析中，我们发现家庭护理访问可降低 HF 相关再入院率[RR（95%CI）=0.56（0.37, 0.84），P=0.005]。此外，护理干预改善了 MLHFQ 和 EQ-5D 的生活质量[标准化均数差值（SMD）（95%CI）=3.38（1.10, 5.66），7.12（2.54, 11.71）]。
研究结果之间的差异可能是由于报告方法、合并症和药物管理教育的不同。患者结局和生活质量也可能因不同的教育方法而有所不同。本荟萃分析的局限性在于原始研究信息报告不完整、样本量小以及仅纳入英语文献。
护士主导的教育方案显著影响心力衰竭患者的 HF 相关再入院率、全因再入院率和死亡率。
结果表明利益相关者应分配资源为心力衰竭患者制定护士主导的教育方案。
