Nurse-Led, Technology-Based Interventions to Improve Self-Care in Heart Failure Patients After Hospital Discharge: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Ismail Fahmi, Tuti Herawati, Imami Nur Rachmawati, Amelia Ganefianty, Bambang Budi Siswanto, Simon StewartAbstract
Aims
To assess the evidence supporting the implementation of nurse-led, technology-based interventions to improve the self-care of patients discharged from hospital with heart failure (HF) and at high risk of poor health outcomes.
Methods
We followed PRISMA guidelines, searching PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, CINAHL, Clinical Key, Cochrane CENTRAL, ClinicalTrials.gov, and Google Scholar for randomized controlled trials (RCTs) comparing post-discharge, nurse-led, technology-based self-care programs (e.g., telehealth education, mobile apps) versus usual care applied to adult HF patients. The main outcome measure was the Self-Care of Heart Failure Index (SCHFI). Data was pooled in RevMan 5.4.1 using random effects.
Results
Overall, 9 RCTs comprising 952 participants with a mean age ∼59–78 years, 65% male and most NHYA Class II-III were included. Seven trials applied telephone-based support, one a mobile-health (mHealth) app, and the other an avatar-based app. Intervention content included structured education, motivational interviewing, and symptom monitoring. Technology-based, nurse-delivered interventions showed statistically significant positive effects on self-maintenance (SMD = 0.97; 95% CI: 0.57–1.37), self-management (SMD = 0.84; 95% CI: 0.40–1.28), and self-confidence (SMD = 0.80; 95% CI: 0.47–1.13) with m-health and telephone-based approaches demonstrating the most significant effects. However, heterogeneity was consistently high across all outcomes (I2 = 82%–90%), which may be explained by variations in follow-up.
Conclusion
Nurse-led, technology-based interventions significantly enhanced self-care maintenance, management, and confidence in post-discharge HF patients, whilst demonstrating other benefits. However, high between-study variability, reflecting diverse care settings, cultures, and technologies, also limits their generalizability.
Registration
PROSPERO CRD42025633134