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ComparEuRecommendationsWeb
We suggest the intervention (Conditional recommendation)
In patients with heart failure, the COMPAR-EU heart failure panel, suggests in favour of the use of monitoring and action-based behavioural techniques, rather than usual care
Justification
The COMPAR-EU heart failure panel made a conditional recommendation in favour of, Education, monitoring and action-based (problem solving and/or goal settings) behavioural techniques, rather than usual care, given a balance that probably favours the intervention (very low quality evidence of effects), the cost-effectiveness evaluation that favours either the intervention or usual care, and an intervention that is probably acceptable for main stakeholders.
Subgroup considerations
Effect of the intervention may differ according to the intensity and duration of the intervention.
Implementation
When implementing SMI in general, the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have adequate communication skills (for example, show empathy, provide understandable information, ask questions);
Patients’ level: patient’s motivation to engage in self-management; patient’s attitude towards self-management (for example, beliefs about the importance of self-management for health, beliefs about the usefulness of certain self-management tasks).
Interaction level: patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
When implementing Education the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have adequate communication skills (for example, show empathy, provide understandable information, ask questions);
Patients’ level: patient’s motivation to engage in self-management; patient’s cognitive and behavioural skills to self-management.
When implementing monitoring techniques, the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to be aware of your attitude toward the patients’ knowledge and personal beliefs.
Patients’ level: patient’s motivation to engage in self-management; patient’s attitude towards self-management.
Interaction level:patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
When implementing action-based behavioural techniques (problem solving and/or goal setting), the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge;
Patients’ level: patient’s motivation to engage in self-management; patient’s attitude towards self-management (for example, beliefs about the importance of self-management for health, beliefs about the usefulness of certain self-management tasks).
Interaction level: patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
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ComparEuEtdsWeb
QUESTION | ||
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01. Should education, monitoring and action-based behavioural techniques vs. Usual Care be used for adult patients living with heart failure? | ||
Population | adult patients living with heart failure | |
Intervention | Monitoring and action-based behavioural techniques See more | |
Comparison | Usual Care | |
Main outcomes | Mortality; Adherence; All cause admission; All cause readmission; Heart Failure admission; Heart Failure readmission; Quality of life; Self-efficacy; Knowledge; Emergency Room Visits(all cause); | |
Setting | European Union, outpatient care | |
Perspective | Clinical recommendation- Population perspective | |
Background | Heart failure (HF), a complex clinical syndrome, is considered a global pandemic with an increasing overall incidence and prevalence due to ageing of population (Savarese G et al., 2017). HF clinical practice guideline self-management strategies are recommended to increase quality of life and to reduce the risk of HF hospitalization and mortality. However, there are still gaps in the evidence especially regarding the comparative effectiveness and cost-effectiveness of the strategies, due to variations in study locations and time of occurrence and to suboptimal reporting of patient-relevant outcomes (ESC 2021, Jonkman NH et al., 2016, Takeda A et al., 2019). | |
Conflict of interest |
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ASSESSMENT | |||||||||||||||||||||||||||||
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Priority of problem Is the problem a priority? |
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Heart failure (HF), a complex clinical syndrome, is considered a global pandemic with an increasing overall incidence and prevalence due to ageing of population (Savarese G et al., 2017). HF clinical practice guideline self-management strategies are recommended to increase quality of life and to reduce the risk of HF hospitalization and mortality. However, there are still gaps in the evidence especially regarding the comparative effectiveness and cost-effectiveness of the strategies, due to variations in study locations and time of occurrence and to suboptimal reporting of patient-relevant outcomes (ESC 2021, Jonkman NH et al., 2016, Takeda A et al., 2019). |
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Desirable Effects How substantial are the desirable anticipated effects? |
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JUDGEMENT | RESEARCH EVIDENCE | ||||||||||||||||||||||||||||
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View summary of findings of network meta-analysis
View summary of findings of component network meta-analysis |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel judged the desirable effects as moderate due to the effect a moderate effect on mortality, and small effect on quality of life and self-efficacy The panel considered the possibilty that the effect of the intervention could differ according to the intensity of the monitoring and duration of the intervention.
No data available for the rest of critical/important outcomes.
Proportion of direct evidence contributing to the final NMA estimate per outcome: - Mortality: 52% - Adherence: 100% - All cause admission: 55% - All cause readmission : 75% - HF admission: 93% - HF readmission: 100% - QoL: 73% - Self-efficacy: 76% - Knowledge: 63% - Emergency Room visits (all cause): 100%
Studies that include this SMI: Blumenthal-2012 - Supervised aerobic exercise (goal of 90 min/wk for months 1-3 followed by home exercise with a goal of 120 min/wk for months 4-12) - 36 face-to-face groups sessions (3 per week), phone calls when needed - Duration 4 years - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring § Medication use and adherence § Managing devices
Bocchi-2008 - Repetitive education at six-month intervals and telephone monitoring - 6 group/individual face-to-face sessions, 60 minutes each; 15 phone calls when needed - Duration 6 years - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction § Alcohol consume, and other harmful consumptions, cessation or reduction o Clinical management § Condition-specific behaviours § Medication use and adherence § Early recognition of symptoms § Asking for professional help or emergency care when needed
Boyne-2014 - Tailored telemonitoring - 2 individual face-to-face sessions - Duration 12 months - Expected patient (or carer) self-management behaviours: o Clinical management § Self-monitoring § Early recognition of symptoms
Kasper-2002 - Multidisciplinary outpatient management by intervention team consisting of telephone nurse coordinator, chronic heart failure (CHF) nurse, CHF cardiologist and primary physician - Individual face-to-face sessions of unknown number, length and frequency; 11 phone calls - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Medication use and adherence
Austin-2009 - Eight-weekly specialist consultations containing exercise prescription, education, dietetics, occupational therapy and psychosocial counselling; 8-week cardiac rehabilitation programme; 16-week community based care regimen consisting of weekly 1-h exercise sessions - 16 group/individual face-to-face sessions, 2.5 hours each, 2 per week - Duration 16 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring § Medication use and adherence § Early recognition of symptoms § Asking for professional help or emergency care when needed
Ortiz-Bautista-2018 - Nurse-led educational counseling - Individual face-to-face sessions; number, length and frequency unclear - Duration unclear - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours o Clinical management § Condition-specific behaviours § Self-monitoring § Early recognition of symptoms § Asking for professional help or emergency care when needed
Capomolla-2004 - Management program delivered by a telemonitoring service - Number and type of sessions unclear - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Early recognition of symptoms § Asking for professional help or emergency care when needed § Managing devices o Working with healthcare and/or social care providers § Communication with health care and/or social care provider
Xueyu-2017 - Low-intensity walking protocol - 1 face-to-face group session, 14 phone calls when needed - Duration 12 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Medication use and adherence § Early recognition of symptoms § Managing devices
Component Network Meta-analysis : - Mortality: the components with larger effects are education (E) and action-based behavioural techniques (AB) - QoL: the components with larger effects are education (E) and monitoring techniques (MT) - Self-efficacy: the components with larger effects are education (E) and monitoring techniques (MT)
Modeling estimations for long term consequences We used the COMPAR-EU heart failure (HF) model developed for the cost-effectiveness analysis to also inform about long-term health outcomes. Decision analytic models can provide valuable information for outcomes when empirical evidence is not available or is unfeasible (Trikalinos TA, 2009).
The following events were estimated over a lifetime and informed by the NMA effect of each SMI on all-cause mortality and all-cause admission outcomes. We suggest cautious interpretation as the certainty of the evidence for those input parameters was low to very low across comparisons.
Long-term model outcomes: - Life-Years (LY): 62 days of additional life per patient - Effect on the all-cause admission: reduction in hospital costs of 876 euros per patient. |
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Undesirable Effects How substantial are the undesirable anticipated effects? |
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View summary of findings of network meta-analysis
No undesirable observed effects. |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel judged the undesirable effects as trivial or marginal or causing no undesirable effects, except for the potential associated burden of the intervention.
The panel agreed that the burden could vary according to the intensity of monitoring. |
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Certainty of the evidence What is the overall certainty of the evidence of effects? |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel judged the certainty of evidence as low due to the certainty of the evidence for mortality.
Certainty of the evidence was downgraded due to heterogeneity (of interventions and severity of disease), risk of bias, and imprecision. |
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Values Is there important uncertainty about or variability in how much people value the main outcomes? |
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An overview of systematic reviews provided information about how patients value several of the outcomes of interest (critical/important) included in this clinical question:
1 Serious concerns in relevance of data, since most findings were collected from patients with HF in advaced stages
References 36 Noonan MC, Wingham J, Taylor RS. “Who Cares?” The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review. BMJ Open. 2018;8(7):e020927. https:// doi. org/ 10. 1136/ bmjopen- 2017- 020927.
56 Jeon YH, Kraus SG, Jowsey T, Glasgow NJ. The experience of living with chronic heart failure: a narrative review of qualitative studies. BMC Health Serv Res. 2010;10:77. https:// doi. org/ 10.1186/ 1472- 6963- 10- 77.
73 Russell S, Ogunbayo OJ, Newham JJ, Heslop-Marshall K, Netts P, Hanratty B, et al. Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: views of patients and healthcare professionals. NPJ Prim Care Respir Med. 2018;28(1):2. https:// doi. org/ 10. 1038/s41533- 017- 0069-z.
49 Falk H, Ekman I, Anderson R, Fu M, Granger B. Older patients’ experiences of heart failure-an integrative literature review. J Nurs Scholarsh. 2013;45(3):247–55. https:// doi. org/ 10. 1111/jnu. 12025.
51 Olano-Lizarraga M, Oroviogoicoechea C, Errasti-Ibarrondo B, Saracibar-Razquin M. The personal experience of living with chronic heart failure: a qualitative meta-synthesis of the literature.J Clin Nurs. 2016;25(17–18):2413–29. https:// doi. org/ 10.1111/ jocn. 13285.
86 Low J, Pattenden J, Candy B, Beattie JM, Jones L. Palliative care in advanced heart failure: an international review of the perspectives of recipients and health professionals on care provision. JCard Fail. 2011;17(3):231–52. https:// doi. org/ 10. 1016/j. cardf ail.2010. 10. 003.
108. Barclay S, Momen N, Case-Upton S, Kuhn I, Smith E. Endof-life care conversations with heart failure patients: a systematic literature review and narrative synthesis. Br J Gen Pract.2011;61(582):e49-62. https:// doi. org/ 10. 3399/ bjgp1 1X549 018.
109. Wingham J, Harding G, Britten N, Dalal H. Heart failure patients’ attitudes, beliefs, expectations and experiences of selfmanagement strategies: a qualitative synthesis. Chronic Illn.2014;10(2):135–54. https:// doi. org/ 10. 1177/ 17423 95313 502993. |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel judged that there is probably no important uncertainty or variabilty y on how patients value the main outcomes.
The panel agreed that there is some variability on how patients value the outcomes, since preferences will vary based on patients' particular starting point, and their disease progression. The panel also noted, that the variability on how patients value the main outcomes, could also depend on the intensity of monitoring. |
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Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison? |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel judged that the balance of effects as probably favors the intervention. This is due to the moderate desirable effects, the trivial undesirable effects, the probably no important uncertainty and variability on how patients value outcomes, as well as the low certainty of evidence of effects. |
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Resources required How large are the resource requirements (costs)? |
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Estimated costs for the intervention across all types of self-management interventions (SMIs), as described in the included studies of the network meta-analysis, were on average 794 euros per patient, with a range from 85 to 2,045 euros. Please note that this average/range estimate has been based on ten cost estimates of SMIs for HF reported in publications.
Model analyses showed that over lifetime the total costs (without cost of the intervention) for the SMI were 2,997 euros higher compared to usual care. This cost increase was mainly the result of an increased life-expectancy with additional costs in the life-years gained. |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
Despite the scarcity of data in available publications, and the important variability in the characteristics of self-monitoring interventions the panel considered that the resources required varies for this SMI.
Resource use and costing data for SMIs should be interpreted with caution. We could not provide cost for any specific type of SMI intervention, because in many publications detailed information needed to estimate the intervention cost was missing (for example number of sessions, average group size or duration of sessions). As an alternative, we searched for intervention cost estimates as presented by the authors of publications and used the average value as an estimate of the average costs of SMI programs for HF in general. |
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Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel agreed on a very low certainty of the evidence on this domain.
Resource use and costing data for SMIs should be interpreted with caution. We could not provide cost for any specific type of SMI intervention, because in many publications detailed information needed to estimate the intervention cost was missing (for example number of sessions, average group size or duration of sessions). As an alternative, we searched for intervention cost estimates as presented by the authors of publications and used the average value as an estimate of the average costs of SMI programs for HF in general.
Further, the costs of the SMI, implementation of SMIs and HF management programs vary between countries and target group. |
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Cost-effectiveness Does the cost-effectiveness of the intervention favor the intervention or the comparison? |
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The table below shows the cost-effectiveness results for the SMI intervention. Costs and QALYs in this analysis were discounted at 3.5% annual rate.
Abbreviations: NA: not applicable; QALY: quality adjusted life years; ICER: incremental cost-effectiveness ratio Explanations The cost-effectiveness results are for the UK setting. For more information on the cost-effectiveness analysis and the results for other countries, please see the cost-effectiveness section. The headroom analysis presented here estimated how much an intervention may maximally cost, based on a willingness-to-pay threshold of €20,000 per QALY. For more information on the headroom analyses and other threshold levels, please see the cost-effectiveness section. |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel judged that the cost-effectiveness does not favor either the intervention or the comparison.
There is a possibility that this specific SMI can be cost-effective, but this depends on the intervention costs of the particular intervention and the threshold used. The intervention may cost 1,102 euro maximum (headroom estimate) when a threshold value of 20,000 euro/QALY is used and 7,249 euro maximum when a threshold value of 50,000 euro/QALY is used.
There is a possibility that this specific SMI can be cost-effective at a threshold of 50,000 euro/QALY because the average cost of SMI for HF in the literature (793 euro, range: 65 to 2,045) is lower than the headroom estimate for 50,000/QALY.
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Equity What would be the impact on health equity? |
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No specific systematic review was conducted for this domain |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The panel agreed that the impact on health equity varies, due to the variability across European countries on the levels of health literacy and socioeconomic status. Equity may be affected by geography and accessibility.
If implemented, tailored to culture and health literacy, ir may increase equity. |
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Acceptability Is the intervention acceptable to key stakeholders? |
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JUDGEMENT | RESEARCH EVIDENCE | ||||||||||||||||||||||||||||
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The information below has been obtained through an overview of systematic reviews of contextual factors, as well as a scoping review and one overview of systematic reviews of values and preferences. It also includes considerations from a Delphi study that was conducted in COMPAR-EU that included the most important contextual factors for the implementation of components (e.g. groups, peers) of self-management interventions according to stakeholders.
References:
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel has judged that this type of SMI is probably acceptable to key stakeholders.
Patients/caregivers: overall acceptable but may vary since it could be influenced by setting, accessibility, tailoring, and other factors. (drop-out varies 0-20%)
Healthcare perspective: It could be time and resource consuming.
Healthcare payers’ perspective: Overall acceptable.
Studie's Interventions Blumenthal-2012 - Supervised aerobic exercise (goal of 90 min/wk for months 1-3 followed by home exercise with a goal of 120 min/wk for months 4-12) - 36 face-to-face groups sessions (3 per week), phone calls when needed - Duration 4 years - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring § Medication use and adherence § Managing devices
Bocchi-2008 - Repetitive education at six-month intervals and telephone monitoring - 6 group/individual face-to-face sessions, 60 minutes each; 15 phone calls when needed - Duration 6 years - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction § Alcohol consume, and other harmful consumptions, cessation or reduction o Clinical management § Condition-specific behaviours § Medication use and adherence § Early recognition of symptoms § Asking for professional help or emergency care when needed
Boyne-2014 - Tailored telemonitoring - 2 individual face-to-face sessions - Duration 12 months - Expected patient (or carer) self-management behaviours: o Clinical management § Self-monitoring § Early recognition of symptoms
Kasper-2002 - Multidisciplinary outpatient management by intervention team consisting of telephone nurse coordinator, chronic heart failure (CHF) nurse, CHF cardiologist and primary physician - Individual face-to-face sessions of unknown number, length and frequency; 11 phone calls - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Medication use and adherence
Austin-2009 - Eight-weekly specialist consultations containing exercise prescription, education, dietetics, occupational therapy and psychosocial counselling; 8-week cardiac rehabilitation programme; 16-week community based care regimen consisting of weekly 1-h exercise sessions - 16 group/individual face-to-face sessions, 2.5 hours each, 2 per week - Duration 16 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring § Medication use and adherence § Early recognition of symptoms § Asking for professional help or emergency care when needed
Ortiz-Bautista-2018 - Nurse-led educational counseling - Individual face-to-face sessions; number, length and frequency unclear - Duration unclear - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours o Clinical management § Condition-specific behaviours § Self-monitoring § Early recognition of symptoms § Asking for professional help or emergency care when needed
Capomolla-2004 - Management program delivered by a telemonitoring service - Number and type of sessions unclear - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Early recognition of symptoms § Asking for professional help or emergency care when needed § Managing devices o Working with healthcare and/or social care providers § Communication with health care and/or social care provider
Xueyu-2017 - Low-intensity walking protocol - 1 face-to-face group session, 14 phone calls when needed - Duration 12 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Medication use and adherence § Early recognition of symptoms § Managing devices |
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Feasibility Is the intervention feasible to implement? |
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JUDGEMENT | RESEARCH EVIDENCE | ||||||||||||||||||||||||||||
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The information below has been obtained through an overview of systematic reviews of contextual factors, as well as a scoping review and one overview of systematic reviews of values and preferences. It also includes considerations from a Delphi study that was conducted in COMPAR-EU that included the most important contextual factors for the implementation of components (e.g. groups, peers) of self-management interventions according to stakeholders.
References:
See Acceptability for studies' interventions |
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ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||||||
The guideline panel judged that the feasibility of implementing this type of SMI varies.
Implementation may be difficult, depending on the context and the use of specific devices for monitoring, for example, online feedback could be more complicated to obtain in certain contexts. and may depend on resources availablity.
Limited human resources, healthcare system coordination and transport services may complicate the implementation of this SMI.
Usually, duration of follow-up was not provided in the studies.
See Acceptability for studies' interventions |
TYPE OF RECOMMENDATION | ||||
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Strong recommendation against the intervention | Conditional recommendation against the intervention | Conditional recommendation for either the intervention or the comparison | Conditional recommendation for the intervention | Strong recommendation for the intervention |
CONCLUSIONS |
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Recommendation |
For patients with heart failure, the COMPAR-EU heart failure panel, suggests in favour of the use of Education, monitoring and action-based (problem solving and/or goal settings) behavioural techniques, rather than usual care (conditional, very low certainty of the evidence about the effects). |
Justification |
The COMPAR-EU heart failure panel made a conditional recommendation in favour of, Education, monitoring and action-based (problem solving and/or goal settings) behavioural techniques, rather than usual care, given a balance that probably favours the intervention (very low quality evidence of effects), the cost-effectiveness evaluation that favours either the intervention or usual care, and an intervention that is probably acceptable for main stakeholders. |
Subgroup considerations |
Effect of the intervention may differ according to the intensity and duration of the intervention. |
Implementation considerations |
When implementing SMI in general, the most important contextual factors to keep in mind are:
When implementing Education the most important contextual factors to keep in mind are:
When implementing monitoring techniques, the most important contextual factors to keep in mind are:
When implementing action-based behavioural techniques (problem solving and/or goal setting), the most important contextual factors to keep in mind are:
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Monitoring and evaluation |
No suggestions |
Research priorities |
- Future studies should measure patient important outcomes, both critical and important (list below), have adequate sample size and follow-up, including after the intervention is finished. - Future studies should address also preferences and values of patients in relation to their self management, cost effectiveness and sub-categories of self-monitoring interventions. - Future studies should describe in detail the aspects of the intervention and evalute the long term effectiveness.
Critical outcomes
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REFERENCES SUMMARY |
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Summary of findings of network meta-analysis
COMPAR-EU Isof Web
Summary of findings of component network meta-analysis
COMPONENT NETWORK META-ANALYSIS (sensitivity analysis)
Components’ effect (95% Confidence Interval) | CNMA effect (95% Confidence Interval) | |||
Outcome | E | MT | AB | |
Mortality | 0,95 (0,79 to 1,14) | 1,02 (0,84 to 1,22) | 0,85 (0,72 to 1,01) | 0,82 (0,68 to 0,98) |
Quality of life | 0.58 (0.25 to 0.91) | 0,05 (-0.25 to 0.35) | -0,06 (-0,33 to 0,20) | 0,7 (0.32 to 0.82) |
Self-efficacy | 0,95 (0,41 to 1,49) | 0,47 (-0,07 to 1,01) | -0,74 (-1,16 to -0,31) | 0,68 (0,18 to 1,18) |
Components' definition:
E: Education; MT Monitoring techniques; AB action-based behavioural techniques
Components
Education (E)
Education (E)
Sharing information. This form of support consists in sharing of information about self-management topics like coping with symptoms, diet, exercise, medication, information about what other people are doing, and information about the disease itself, or about any other relevant aspects that could lead to improved self-management, and ultimately better health. This information can be told or distributed in printed materials like a folder or workbook, or via website or DVD.
Examples: Educational session on healthy eating for people with obesity, provision of a printed leaflet on the importance of foot care in diabetes, or a link to a website with information on chronic obstructive pulmonary disease care.
Monitoring techniques (MT)
Monitoring techniques (MT)
Self-monitoring training and feedback. Training and encouraging people to recognize, monitor, and record behaviours, symptoms, or clinical data. This process may include regular feedback from a clinician, or a synopsis of information registered in a digital tool to encourage you to continue monitoring your illness and behaviours.
Example: Showing a patient how to record blood sugar levels, physical activity, or pain.
Action-based behavioural change techniques (AB)
Action-based behavioural change techniques (AB)
There are different action-based behavioural change techniques:
Enhancing problem-solving skills. This technique consists in teaching on how to analyse factors that influence your behaviour and provide you or help you to develop strategies to reduce or overcome barriers and/or support facilitators (e.g., not eating unhealthy foods when you feel depressed). Strategies include anticipation, self-treatment, resource utilization, and problem management. Ideally, there should be an initial plan, but this is not a requisite.
Example: Identification and attenuation of environmental barriers (e.g., no gym in the neighbourhood when one want to exercise) and facilitators (e.g., someone who keeps you company during exercise) to everyday physical activities.
Goal setting and action planning. This technique consists in encouraging you to set one or more achievable goals based on your needs and preferences. These goals may be behaviours (e.g., a consuming a healthy meal three times a day) or outcomes (e.g., less pain) and can be used as a starting point. The process usually involves the formulation of a detailed action plan, specifying what you would do and at least when and/or where you will do it. It could also include an assessment of your behaviours with your health care provider and a discussion of goals and the writing up of agreed-on action plans, including plans for emergency situations.
Examples of goals: achieving a daily walking distance of 2 km or a weight loss of some kilograms in x months with diet and exercise.
Individual sessions
A single person receives the self-management support. Examples: self-guided actions (without the participation of any other person) during a clinical visit or within the context of a support or educational session
Face-to-face
Self-management support delivered in a face-to-face encounter between the providers and patients and/or caregivers.
Συμμόρφωση σε φαρμακευτική αγωγή ή άλλη θεραπεία [Καρδιακή Ανεπάρκεια] | Θνησιμότητα [Καρδιακή ανεπάρκεια] | Εισαγωγές στο νοσοκομείο [Καρδιακή ανεπάρκεια] | Ικανότητα άσκησης (συμπεριλαμβανομένου του τεστ κοπώσεως) [Καρδιακή ανεπάρκεια] | Γνώση [Καρδιακή ανεπάρκεια] | Ποιότητα ζωής [Καρδιακή Ανεπάρκεια] | Αυτοαποτελεσματικότητα [Καρδιακή ανεπάρκεια] | |
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Τεχνικές παρακολούθησης και συμπεριφορικές τεχνικές εστιασμένες στη δράση | |||||||
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Evidence table description for recommendations section
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Πρακτικές παράμετροι
Research priorities
- Future studies should measure patient important outcomes, both critical and important (list below), have adequate sample size and follow-up, including after the intervention is finished.
- Future studies should address also preferences and values of patients in relation to their self management, cost effectiveness and sub-categories of self-monitoring interventions.
- Future studies should describe in detail the aspects of the intervention and evalute the long term effectiveness.
Critical outcomes
Knowledge
Self-efficacy
Patient activation
Quality of life
Mortality
Emergency visits
Admission all cause
Admission HF
Readmissions all cause
Readmissions HF
Adherence
Exercise capacity
Background
Heart failure (HF), a complex clinical syndrome, is considered a global pandemic with an increasing overall incidence and prevalence due to ageing of population (Savarese G et al., 2017). HF clinical practice guideline self-management strategies are recommended to increase quality of life and to reduce the risk of HF hospitalization and mortality. However, there are still gaps in the evidence especially regarding the comparative effectiveness and cost-effectiveness of the strategies, due to variations in study locations and time of occurrence and to suboptimal reporting of patient-relevant outcomes (ESC 2021, Jonkman NH et al., 2016, Takeda A et al., 2019).