Iyngkaran Pupalan, Patel Taksh, Asadi Diana, Siddique Iqra, Gupta Bhawna, de Courten Maximilian, Hanna Fahad
Cardiology, University of Notre Dame, Sydney, NSW 2007, Australia.
Program of Public Health, Department of Health and Education, Torrens University Australia, Melbourne, VIC 3000, Australia.
Biomedicines. 2025 Aug 11;13(8):1955. doi: 10.3390/biomedicines13081955.
Chronic disease self-management (CDSM) programmes are widely recommended for heart failure with reduced ejection fraction (HFrEF), yet evidence on their effectiveness remains mixed. This systematic review synthesises the evidence and critically appraises the findings from multiple systematic reviews on CDSM for congestive heart failure (CHF) with a focus on the impact of nurse-led and multidisciplinary CDSM interventions in adults with HFrEF. Systematic review using PRISMA 2020 and AMSTAR-2 guidelines. We searched MEDLINE, Embase, CINAHL, Cochrane Library, and other sources for reviews published from 2012 to 2024. Included were systematic reviews of CDSM interventions for adults diagnosed with HFrEF, focusing on mortality, hospital readmissions, quality of life, and self-management behaviours. A total of 1050 studies were screened, with 60 studies being counted in the final analysis, including 22 reviews of high quality. Evidence for mortality benefit was limited and inconsistent across reviews. However, moderate-to-high-certainty evidence showed that nurse-led CDSM interventions improved hospital readmission rates and health-related quality of life (HRQoL). Improvements in self-management behaviours such as medication adherence and symptom monitoring were also frequently reported. While evidence for a mortality benefit remains inconclusive, this review highlights consistent benefits of nurse-led CDSM interventions in reducing readmissions and improving HRQoL for HFrEF patients. Future research should prioritise standardised outcome reporting, incorporate economic evaluations, and explore patient-centred and culturally tailored approaches to intervention design. PROSPERO registration number CRD42023431539.
慢性疾病自我管理（CDSM）项目被广泛推荐用于射血分数降低的心力衰竭（HFrEF）患者，但其有效性的证据仍存在分歧。本系统评价综合了相关证据，并对多项关于充血性心力衰竭（CHF）的CDSM系统评价的结果进行了批判性评估，重点关注护士主导和多学科CDSM干预对HFrEF成年患者的影响。采用PRISMA 2020和AMSTAR - 2指南进行系统评价。我们检索了MEDLINE、Embase、CINAHL、Cochrane图书馆和其他来源，以查找2012年至2024年发表的综述。纳入的是对诊断为HFrEF的成年患者CDSM干预的系统评价，重点关注死亡率、住院再入院率、生活质量和自我管理行为。共筛选了1050项研究，最终分析纳入60项研究，其中包括22项高质量综述。各综述中关于死亡率获益的证据有限且不一致。然而，中到高确定性的证据表明，护士主导的CDSM干预可改善住院再入院率和健康相关生活质量（HRQoL）。药物依从性和症状监测等自我管理行为的改善也经常被报道。虽然死亡率获益的证据尚无定论，但本综述强调了护士主导的CDSM干预在降低HFrEF患者再入院率和改善HRQoL方面的一致益处。未来的研究应优先考虑标准化结局报告，纳入经济评估，并探索以患者为中心和文化定制的干预设计方法。PROSPERO注册号CRD42023431539。
