3
Metas de Enfermería

Metas de Enfermería

ABRIL 2022 N° 3 Volumen 25

Educational interventions to reduce the mortality and increase the quality of life in adults with heart failure

Section: Revisiones

How to quote

Cañón-Montañez W, Duque-Cartagena T, López de Ávila M, Rodríguez-Acelas AL. Intervenciones educativas para reducir mortalidad y aumento de calidad de vida en adultos con insuficiencia cardiaca: revisión sistemática y metaanálisis. Metas Enferm abr 2022; 25(3):7-16. Doi: https://doi.org/10.35667/MetasEnf.2022.25.1003081902

Authors

Wilson Cañón Montañez1, Tatiana Duque Cartagena2, Mónica López de Ávila3, Alba Luz Rodríguez Acelas4

Position

1Doctor en Epidemiología. Facultad de Enfermería. Universidad de Antioquia. Medellín (Colombia) 2Enfermera. Facultad de Enfermería. Universidad de Antioquia. Medellín (Colombia) 3Estudiante de Enfermería. Facultad de Enfermería. Universidad de Antioquia. Medellín (Colombia) 4Doctora en Enfermería. Facultad de Enfermería. Universidad de Antioquia. Medellín (Colombia)

Contact address

Wilson Cañón-Montañez. Facultad de Enfermería. Universidad de Antioquia. Calle 64 #53-09. 050010 Medellín (Colombia)

Contact email: wilson.canon@udea.edu.co

Abstract

Objective: to estimate the effect of educational intervention (EI) studies on the reduction of mortality and the increase in quality of life (QoL) in adults with heart failure, compared with standard care.

Method: a systematic review (SR) and meta-analysis (MA) of randomized clinical trials, following the recommendations of the PRISMA declaration. The protocol was registered in PROSPERO (CRD42019139321). Searches were conducted in PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science and Scopus since the start of the year and until July 2019. The MA was conducted through random effects model. The measure of effect used for the mortality outcome was Relative Risk (RR), and the mean difference (MD) was used for the QoL outcome, with 95% confidence interval (CI). Heterogeneity was assessed through inconsistency statistics (I2).

Results: fifty-eight (58) studies were included out of the 2.369 studies identified. For the mortality outcome, the MA with follow-up at ≥ 12 months, there was a 26% reduction in mortality (RR: 0.74; CI 95%: 0.66-0.83; I2: 0%) in favour of the EI group. For the QoL outcome (Minnesota Living with Heart Failure Questionnaire), the MA with follow-up at ≤ 3 months showed an increase in QoL in favour of the EI group, with a relevant difference in score by almost 7 points (MD: -6.77; CI 95%: -9.85, -3.69; I2: 23%).

Conclusions: the findings demonstrated the protective effect of EIs for reducing mortality and increasing the QoL of adult patients with heart failure.

Keywords:

heart failure; mortality; quality of life; patient education; Systematic review; meta-analysis

Versión en Español

Título:

Intervenciones educativas para reducir mortalidad y aumento de calidad de vida en adultos con insuficienciacardiaca: revisión sistemática y metaanálisis

Artículo completo no disponible en este idioma / Full article is not available in this language

Bibliography

  1. Mascote JE, Salcedo DM. Prevalencia de factores de riesgo para insuficiencia cardiaca y discusión de sus posibles interacciones fisiopatológicas. Rev Med Vozandes [internet]. 2018 [citado 16 feb 2022]; 29(2):55-65. Disponible en: https://docs.bvsalud.org/biblioref/ 2019/05/997050/ao_01.pdf
  2. Khalil H, Bell B, Chambers H, Sheikh A, Avery AJ. Professional, structural and organisational interventions in primary care for reducing medication errors. Cochrane Database Syst Rev. 2017; 10:CD003942. Doi: https:doi.org/10.1002/14651858.CD003942.pub3
  3. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017; 3:7-11. Doi: https://doi.org/10.15420/cfr.2016:25:2
  4. Lesyuk W, Kriza C, Kolominsky-Rabas P. Cost-of-illness studies in heart failure: a systematic review 2004-2016. BMC Cardiovasc Disord. 2018; 18:74. Doi: https://doi.org/10.1186/s12872-018-0815-3
  5. Alonso-Pulpón L. La «epidemia» de insuficiencia cardiaca: ¿son todos los que están y están todos los que son? Rev Esp Cardiol [internet]. 2002 [citado 16 feb 2022]; 55:211-4. Disponible en: https://www.revespcardiol.org/es-la-epidemia-insuficiencia-cardiaca-son-articulo-13027541
  6. Gómez E. Introducción, epidemiología de la falla cardiaca e historia de las clínicas de falla cardiaca en Colombia. Rev Colomb Cardiol. 2016; 23:6-12. Doi: https://doi.org/10.1016/j.rccar.2016.01.004
  7. Cañón-Montañez W, Duque-Cartagena T, Rodríguez-Acelas AL. Effect of Educational Interventions to Reduce Readmissions due to Heart Failure Decompensation in Adults: a Systematic Review and Meta-analysis. Invest. Educ. Enferm. 2021; 39(2):e05. Doi: https://doi.org/10.17533/udea.iee.v39n2e05
  8. Cañón-Montañez W, López de Ávila M, Rodríguez-Acelas AL. Programas de autocuidado y rol de la enfermería para mejorar los resultados clínicos en pacientes con insuficiencia cardiaca. Rev Enferm Referência. [internet] 2020 [citado 16 feb 2022]; V(3):1-6. Disponible en: http://scielo.pt/pdf/ref/vserVn3/vserVn3a01.pdf
  9. Farmakis D, Papingiotis G, Parissis J. Acute heart failure: Epidemiology and socioeconomic burden. Contin Cardiol Educ. 2017; 3:88-92. Doi: https://doi.org/10.1 002/cce2.61
  10. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Med. 2009; 6:e1000097. Doi: https://doi.org/10.137 1/journal.pmed.1000097
  11. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds.). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane [internet] 2021 [citado 16 feb 2022]. Disponible en: https://training.cochrane.org/handbook
  12. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. Doi: https://doi.org/10.1136/bmj.d5928
  13. Aguado O, Morcillo C, Delàs J, Rennie M, Bechich S, Schembari A, et al. Long-term implications of a single home-based educational intervention in patients with heart failure. Heart Lung. 2010; 39(6 Suppl): S14-22. Doi: https://doi.org/10.1016/j.hrtlng.2010.04.010
  14. Aldamiz-Echevarría Iraúrgui B, Muñiz J, Rodríguez-Fernández JA, Vidán-Martínez L, Silva-César M, Lamelo-Alfonsín F, et al. Ensayo clínico aleatorizado y controlado para valorar una intervención por una unidad de hospitalización domiciliaria en la reducción de reingresos y muerte en pacientes dados de alta del hospital tras un ingreso por insuficiencia cardiaca. Rev Esp Cardiol. 2007; 60:914-22. Doi: https://doi.org/10. 1157/13109644
  15. Atienza F, Anguita M, Martínez-Alzamora N, Osca J, Ojeda S, Almenar L, et al. Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program. Eur J Heart Fail. 2004; 6:643-52. Doi: https://doi.org/10.1016/j.ejheart.2003.11.023
  16. Baker DW, DeWalt DA, Schillinger D, Hawk V, Ruo B, Bibbins-Domingo K, et al. The Effect of Progressive, Reinforcing Telephone Education and Counseling Versus Brief Educational Intervention on Knowledge, Self-Care Behaviors and Heart Failure Symptoms. J Card Fail. 2011; 17:789-96. Doi: https://doi.org/10.1 016/j.cardfail.2011.06.374
  17. Blue L, Lang E, McMurray JJV, Davie AP, McDonagh TA, Murdoch DR, et al. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ. 2001; 323:715-8. Doi: https://doi.org/10.1136/bmj. 323.7315.715
  18. Brotons C, Falces C, Alegre J, Ballarín E, Casanovas J, Catà T, et al. Ensayo clínico aleatorizado para evaluar la efectividad de una intervención domiciliaria en pacientes con insuficiencia cardiaca: estudio IC-DOM. Rev Esp Cardiol. 2009; 62:400-8. Doi: https://doi.org/10.1016/S0300-8932(09)70897-8
  19. Cañón-Montañez W, Oróstegui M. Intervenciones educativas de enfermería en pacientes ambulatorios con falla cardiaca. Enferm Glob. 2013; 12(3):52-67. Doi: https://doi.org/10.6018/eglobal.12.3.160411
  20. Chen Y, Funk M, Wen J, Tang X, He G, Liu H. Effectiveness of a multidisciplinary disease management program on outcomes in patients with heart failure in China: A randomized controlled single center study. Heart Lung. 2018; 47(1):24-31. Doi: https://doi.org/10.1016/j.hrtlng.2017.10.002
  21. Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, et al. Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure. J Cardiovasc Nurs. 2015; 30:S3. Doi: https://doi.org/ 10.1097/JCN.0000000000000169
  22. Cui X, Zhou X, Ma L, Sun T-W, Bishop L, Gardiner FW, et al. A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. Rural Remote Health. 2019; 19:5270. Doi: https://doi.org/10.22605/RRH5270
  23. De Souza EN, Rohde LE, Ruschel KB, Mussi CM, Beck-da-Silva L, Biolo A, et al. A nurse-based strategy reduces heart failure morbidity in patients admitted for acute decompensated heart failure in Brazil: the HELEN-II clinical trial. Eur J Heart Fail. 2014; 16:1002-8. Doi: https://doi.org/10.1002/ejhf.125
  24. DeBusk RF, Miller NH, Parker KM, Bandura A, Kraemer HC, Cher DJ, et al. Care Management for Low-Risk Patients with Heart Failure. Ann Intern Med. 2004; 141:606-13. Doi: https://doi.org/10.7326/0003-48 19-141-8-200410190-00008
  25. Delaney C, Apostolidis B, Bartos S, Morrison H, Smith L, Fortinsky R. A Randomized Trial of Telemonitoring and Self-Care Education in Heart Failure Patients Following Home Care Discharge. Home Health Care Manag Pract. 2013; 25:187-95. Doi: https://doi.org/10.1177/1084822312475137
  26. DeWalt DA, Malone RM, Bryant ME, Kosnar MC, Corr KE, Rothman RL, et al. A heart failure self-management program for patients of all literacy levels: A randomized, controlled trial [ISRCTN11535170]. BMC Health Serv Res. 2006; 6:30. Doi: https://doi.org/ 10.1186/1472-6963-6-30
  27. Dickson VV, Melkus GD, Katz S, Levine-Wong A, Dillworth J, Cleland CM, et al. Building skill in heart failure self-care among community dwelling older adults: Results of a pilot study. Patient Educ Couns. 2014; 96:188-96. Doi: https://doi.org/10.1016/j.pec.2014.04.018
  28. Domingues FB, Clausell N, Aliti GB, Domínguez DR, Rabelo ER. Education and telephone monitoring by nurses of patients with heart failure: randomized clinical trial. Arq Bras Cardiol. 2011; 96:233-9. Doi: https://doi.org/10.1590/S0066-782X2011005000014
  29. Doughty RN, Wright SP, Pearl A, Walsh HJ, Muncaster S, Whalley GA, et al. Randomized, controlled trial of integrated heart failure management. The Auckland Heart Failure Management Study. Eur Heart J. 2002; 23:139-46. Doi: https://doi.org/10.1053/euhj.2001.2712
  30. Dracup K, Moser DK, Pelter MM, Nesbitt TS, Southard J, Paul SM, et al. Randomized, Controlled Trial to Improve Self-Care in Patients With Heart Failure Living in Rural Areas. Circulation. 2014; 130:256-64. Doi: https://doi.org/10.1161/CIRCULATIONAHA.113.003542
  31. Ducharme A, Doyon O, White M, Rouleau JL, Brophy JM. Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial. CMAJ. 2005; 173:40-5. Doi: https://doi.org/10.1503/cmaj.1041137
  32. Dunbar SB, Reilly CM, Gary R, Higgins MK, Culler S, Butts B, et al. Randomized Clinical Trial of an Integrated Self-Care Intervention for Persons With Heart Failure and Diabetes: Quality of Life and Physical Functioning Outcomes. J Card Fail. 2015; 21:719-29. Doi: https://doi.org/10.1016/j.cardfail.2015.05.012
  33. Gámez-López AL, Bonilla-Palomas JL, Anguita-Sánchez M, Castillo-Domínguez JC, Arizón del Prado JM, Suárez de Lezo J. Efectos sobre la mortalidad y reingresos hospitalarios de tres tipos distintos de programas de intervención en pacientes hospitalizados por insuficiencia cardiaca: ensayo clínico aleatorizado. Med Clin. 2012; 138:192-8. Doi: https://doi.org/10.1016/j.medcli.2011.03.027
  34. González-Guerrero JL, Alonso-Fernández T, García-Mayolín N, Gusi N, Ribera-Casado JM. Effectiveness of a follow-up program for elderly heart failure patients after hospital discharge. A randomized controlled trial. Eur Geriatr Med. 2014; 5:252-7. Doi: https://doi.org/10.1016/j.eurger.2014.05.005
  35. González-Guerrero JL, Hernández-Mocholi MA, Ribera-Casado JM, García-Mayolín N, Alonso-Fernández T, Gusi N. Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial. Eur Geriatr Med. 2018; 9:523-32. Doi: https://doi.org/10.1007/s41999-018-0074-y
  36. Gwadry-Sridhar FH, Arnold JMO, Zhang Y, Brown JE, Marchiori G, Guyatt G. Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure. Am Heart J. 2005; 150:982.e1-982.e9. Doi: https://doi.org/10.10 16/j.ahj.2005.08.016
  37. Hägglund E, Lyngå P, Frie F, Ullman B, Persson H, Melin M, et al. Patient-centred home-based management of heart failure. Scand Cardiovasc J. 2015; 49:193-9. Doi: https://doi.org/10.3109/14017431.2015.1035319
  38. Holland R, Brooksby I, Lenaghan E, Ashton K, Hay L, Smith R, et al. Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial. BMJ. 2007; 334:1098. Doi: https://doi.org/10.1136/bmj.39164.568183.AE
  39. Jaarsma T, Halfens R, Huijer Abu-Saad H, Dracup K, Gorgels T, van Ree J, et al. Effects of education and support on self-care and resource utilization in patients with heart failure. Eur Heart J. 1999; 20:673-82. Doi: https://doi.org/10.1053/euhj.1998.1341
  40. Jaarsma T, van der Wal MHL, Lesman-Leegte I, Luttik M-L, Hogenhuis J, Veeger NJ, et al. Effect of moderate or intensive disease management program on outcome in patients with heart failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). Arch Intern Med. 2008; 168:316-24. Doi: https://doi.org/10.1001/archinternmed.2007.83
  41. Kato NP, Kinugawa K, Sano M, Kogure A, Sakuragi F, Kobukata K, et al. How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study. Patient Prefer Adherence. 2016; 10:171-81. Doi: https://doi.org/10.2147/PPA.S100203
  42. Koelling TM, Johnson ML, Cody RJ, Aaronson KD. Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure. Circulation. 2005; 111:179-85. Doi: https://doi.org/10.1161/01.CIR.0000151811.53450.B8
  43. Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, et al. Randomized trial of an education and support intervention to preventreadmission of patients with heart failure. J Am Coll Cardiol. 2002; 39:83-9. Doi: https://doi.org/10.1016/S0735-1097(01)01699-0
  44. Leventhal ME, Denhaerynck K, Brunner-La Rocca H-P, Burnand B, Conca-Zeller A, Bernasconi AT, et al. Swiss Interdisciplinary Management Programme for Heart Failure (SWIM-HF): a randomised controlled trial study of an outpatient inter-professional management programme for heart failure patients in Switzerland. Swiss Med Wkly. 2011; 141:w13171. Doi: https://doi.org/10.4414/smw.2011.13171
  45. Linné AB, Liedholm H. Effects of an interactive CD-program on 6 months readmission rate in patients with heart failure-a randomised, controlled trial [NCT00311194]. BMC Cardiovasc Disord. 2006; 6:30. Doi: https://doi.org/10.1186/1471-2261-6-30
  46. Mau MKLM, Lim E, Kaholokula JK, Loui TM, Cheng Y, Seto TB. A randomized controlled trial to improve heart failure disparities: the Malama Pu'uwai (caring for heart) Study. Open Access J Clin Trials. 2017; 9:65-74. Doi: https://doi.org/10.2147/OAJCT.S136066
  47. Mehralian H, Salehi S, Moghaddasi J, Amiri M, Rafiei H. The Comparison of the Effects of Education Provided by Nurses on the Quality of Life in Patients with Congestive Heart Failure (CHF) in Usual and Home-Visit Cares in Iran. Glob J Health Sci. 2014; 6(3):256-60. Doi: https://doi.org/10.5539/gjhs.v6n3p256
  48. Mejhert M, Kahan T, Persson H, Edner M. Limited long term effects of a management programme for heart failure. Heart. 2004; 90:1010-5. Doi: https://doi.org/10.1136/hrt.2003.014407
  49. Melin M, Hägglund E, Ullman B, Persson H, Hagerman I. Effects of a Tablet Computer on Self-care, Quality of Life, and Knowledge: A Randomized Clinical Trial. J Cardiovasc Nurs. 2018; 33:336-43. Doi: https://doi.org/10.1097/JCN.0000000000000462
  50. Meng K, Musekamp G, Schuler M, Seekatz B, Glatz J, Karger G, et al. The impact of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation. Patient Educ Couns. 2016; 99:1190-7. Doi: https://doi.org/10.1016/j.pec.2016.02.010
  51. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004; 52:675-84. Doi: https://doi.org/10.1111/j.1532-5415.2004.52202.x
  52. Nucifora G, Albanese MC, De Biaggio P, Caliandro D, Gregori D, Goss P, et al. Lack of improvement of clinical outcomes by a low-cost, hospital-based heart failure management programme. J Cardiovasc Med (Hagerstown). 2006; 7:614-22. Doi: https://doi.org/10.2459/01.JCM.0000237910.34000.58
  53. Ong MK, Romano PS, Edgington S, Aronow HU, Auerbach AD, Black JT, et al. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Intern Med. 2016; 176:310-8. Doi: https://doi.org/10.1001/jamainternmed.2015.7712
  54. Otsu H, Moriyama M. Effectiveness of an educational self-management program for outpatients with chronic heart failure. Jpn J Nurs Sci. 2011; 8:140-52. Doi: https://doi.org/10.1111/j.1742-7924.2010.00166.x
  55. Ramachandran K, Husain N, Maikhuri R, Seth S, Vij A, Kumar M, et al. Impact of a comprehensive telephone-based disease management programme on quality-of-life in patients with heart failure. Natl Med J India. [internet] 2007 [citado 16 feb 2022]; 20:67-73. Disponible en: https://pubmed.ncbi.nlm.nih.gov/ 17802984/
  56. Ruschel KB, Rabelo-Silva ER, Rohde LE, de Souza EN, Mussi CM, Polanczyk CA. Cost-Effectiveness of a Home Visit Program for Patients with Heart Failure in Brazil: Evidence from a Randomized Clinical Trial. Value Health Reg Issues. 2018; 17:81-7. Doi: https://doi.org/10.1016/j.vhri.2018.03.006
  57. Shearer NBC, Cisar N, Greenberg EA. A telephone-delivered empowerment intervention with patients diagnosed with heart failure. Heart Lung. 2007; 36:159-69. Doi: https://doi.org/10.1016/j.hrtlng.2006.08.006
  58. Sun J, Zhang Z-W, Ma Y-X, Liu W, Wang C-Y. Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors. World J Clin Cases. 2019; 7:2165-75. Doi: https://doi.org/10.12998/wjcc.v7.i16.2165
  59. Sethares KA, Elliott K. The effect of a tailored message intervention on heart failure readmission rates, quality of life, and benefit and barrier beliefs in persons with heart failure. Heart Lung. 2004; 33:249-60. Doi: https://doi.org/10.1016/j.hrtlng.2004.03.005
  60. Strömberg A, Dahlström U, Fridlund B. Computer-based education for patients with chronic heart failure. A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life. Patient Educ Couns. 2006; 64:128-35. Doi: https://doi.org/10.1016/j.pec.2005.12.007
  61. Thompson DR, Roebuck A, Stewart S. Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure. Eur J Heart Fail. 2005; 7:377-84. Doi: https://doi.org/ 10.1016/j.ejheart.2004.10.008
  62. Tomita MR, Tsai B-M, Fisher NM, Kumar NA, Wilding G, Stanton K, et al. Effects of multidisciplinary Internet-based program on management of heart failure. J Multidiscip Healthc. 2008; 2:13-21. Doi: https://doi.org/10.2147/jmdh.s4355
  63. Tsuchihashi-Makaya M, Matsuo H, Kakinoki S, Takechi S, Kinugawa S, Tsutsui H, et al. Home-based disease management program to improve psychological status in patients with heart failure in Japan. Circ J. 2013; 77:926-33. Doi: https://doi.org/10.1253/circj.cj-13-0115
  64. Van Spall HGC, Lee SF, Xie F, Oz UE, Perez R, Mitoff PR, et al. Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure: The PACT-HF Randomized Clinical Trial. JAMA. 2019; 321:753-61. Doi: https://doi.org/10.1001/jama.2019.0710
  65. Wagenaar KP, Broekhuizen BDL, Jaarsma T, Kok I, Mosterd A, Willems FF, et al. Effectiveness of the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters.org’ and an e-health adjusted care pathway in patients with stable heart failure: results of the ‘e-Vita HF’ randomized controlled trial. Eur J Heart Fail. 2019; 21:238-46. Doi: https://doi.org/10.1002/ejhf.1354
  66. Wakefield BJ, Ward MM, Holman JE, Ray A, Scherubel M, Burns TL, et al. Evaluation of home telehealth following hospitalization for heart failure: a randomized trial. Telemed J E Health. 2008; 14:753-61. Doi: https://doi.org/10.1089/tmj.2007.0131
  67. Wierzchowiecki M, Poprawski K, Nowicka A, Kandziora M, Piatkowska A, Jankowiak M, et al. A new programme of multidisciplinary care for patients with heart failure in Poznan: one-year follow-up. Kardiol Pol. 2006; 64:1063-70. Disponible en: https://pubmed.ncbi.nlm.nih.gov/17089238/
  68. Wright SP, Walsh H, Ingley KM, Muncaster SA, Gamble GD, Pearl A, et al. Uptake of self-management strategies in a heart failure management programme. Eur J Heart Fail. 2003; 5:371-80. Doi: https://doi.org/ 10.1016/s1388-9842(03)00039-4
  69. Yu M, Chair SY, Chan CWH, Choi KC. A health education booklet and telephone follow-ups can improve medication adherence, health-related quality of life, and psychological status of patients with heart failure. Heart Lung. 2015; 44:400-7. Doi: https://doi.org/10.1016/j.hrtlng.2015.05.004
  70. Yu H, Zhang P, Wang X, Wang Y, Zhang B. Effect of Health Education Based on Behavioral Change Theories on Self-Efficacy and Self-Management Behaviors in Patients with Chronic Heart Failure. Iran J Public Health. [internet] 2019 [citado 16 feb 2022]; 48:421-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31223568/
  71. Takeda A, Martin N, Taylor RS, Taylor SJ. Disease management interventions for heart failure. Cochrane Database Syst Rev. 2019; 1(1):CD002752. Doi: https://doi.org/10.1002/14651858.CD002752.pub4
  72. Oyanguren J, Latorre García PM, Torcal Laguna J, Lekuona Goya I, Rubio Martín S, Maull Lafuente E, et al. Efectividad y determinantes del éxito de los programas de atención a pacientes con insuficiencia cardiaca: revisión sistemática y metanálisis. Rev Esp Cardiol. 2016; 69:900-14. Doi: https://doi.org/10.10 16/j.recesp.2016.05.008
  73. Feltner C, Jones CD, Cené CW, Zheng Z-J, Sueta CA, Coker-Schwimmer EJL, et al. Transitional Care Interventions to Prevent Readmissions for Persons With Heart Failure. Ann Intern Med. 2014; 160:774-84. Doi: https://doi.org/10.7326/M14-0083
  74. Rice H, Say R, Betihavas V. The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review. Patient Educ Couns. 2018; 101:363-74. Doi: https://doi.org/10.1016/j.pec.2017.10.002
  75. González M, Pedrero V. Estrategias de intervención para mejorar la calidad de vida en pacientes con insuficiencia cardiaca. Rev Chil Cardiol. 2013; 32:134-40. Doi: https://doi.org/10.4067/S0718-85602013000 200008
  76. Cañón-Montañez W, Duque-Cartagena T, Rodríguez-Acelas AL. Intervenciones educativas para el manejo de la falla cardiaca: estrategias para mejorar los desenlaces clínicos de los pacientes. Av Enferm. 2021; 39(1):7-10. Doi: https://doi.org/10.15446/avenferm.v39n1.91884