Effectiveness of an internet-based support programme for informal caregivers of patients with heart failure: a randomised controlled trial

Background and aims

Patients with heart failure (HF) often depend on support from informal caregivers. However, these family, friends and/or neighbours often experience substantial mental strain and uncertainty related to their caregiving tasks. Digital support interventions may help improve caregivers’ preparedness and confidence in their caregiving role, but evidence from randomised trials remains limited. This study aimed to determine the effects of an internet-based support programme for caregivers of patients with HF. The primary outcome was change in preparedness for caregiving, assessed using the Preparedness for Caregiving Scale. In addition, the study aimed to explore other aspects of caregiving experiences, including caregivers’ competence, perceived rewards of caregiving, sleep and mental wellbeing.

Methods

This single-blind parallel two-arm randomised controlled trial included informal caregivers of patients with HF. Informal carers were identified and recruited via patients diagnosed with HF (ICD-10 codes I42, I50) from HF clinics. The trial was performed in six health care regions (7 sites) across Sweden between October 2021 and June 2025.

Participants were randomly assigned to either the intervention group, which received access to a digital support programme for three months, or the control group, which received usual support from health care. The programme included educational modules, self-reflection exercises, and practical tools to support caregiving. The primary outcome and the normally distributed secondary outcomes were analysed using Linear Mixed Models for repeated measures. For the other not normally distributed secondary outcomes the Mann–Whitney U tests were applied.

Results

A total of 202 caregivers (83% women, mean age 64) were enrolled and randomised (intervention n=101, control n=101). About half were retired (53%), and 79% lived with the patients with heart failure, most commonly as a partner (76%). Caregivers mainly provided emotional and social support (74%) and household assistance (63%). The caregivers’ overall health and quality of life were moderate to good, although 43% of the caregivers reported some activity limitations due to health problems.

Participants in the intervention group showed statistically significant improvements in preparedness for caregiving compared with the comparator group (mean difference = 2.37, p<0.007). In addition, sleep quality improved in the intervention group compared with the control group (adjusted mean difference = −0.61, p<0.05). There were no significant differences between the groups in caregivers’ competence, perceived rewards of caregiving, or mental wellbeing.

Conclusions

The digital support programme improved informal caregivers’ preparedness for caregiving and sleep quality. These findings suggest that structured digital interventions can enhance caregiver preparedness and may complement usual caregiver support for patients with HF.