What works for caregivers in advanced heart failure: a systematic review

Background: There is increasing evidence that caregivers of patients with heart failure can experience physical,
emotional and financial stress (Doherty et al 2015 and Clark et al 2008) while supporting the patient with selfcare. There is limited healthcare support and information available therefore it is imperative to identify effective
resources that are tailored to meet the needs of caregivers.
Purpose: To assess how effective psycho­educational resources are at improving caregiver burden, caregiver
strain, depression, perceived confidence and heart failure related knowledge and help to inform the components
of a supportive interventional study.
Methods: Search terms were grouped under three concepts: caregiver, intervention study and heart failure and
five databases (PsychInfo, Medline, CINAHL Plus, EMBASE, and SCOPUS) were systematically searched to
identify studies using psycho­educational resources. Inclusion criteria determined that interventional studies
published in English over the last ten years (2007­2017) would be included. Three reviewers independently
screened, extracted data and assessed the quality of included studies. Synthesis of data was undertaken
narratively to identify patterns across all of the included studies and key similarities were grouped in tabular
form.
Results: Nine interventional studies originating from six different countries included a population of 1239
participants. Outcome measures included: reduced caregiver burden, caregiver strain, depression, increased
perceived confidence and improved heart failure related knowledge. Two American studies, one Chinese study
and a study from Thailand found educational information, in the form of a booklet significantly improved heart
failure related knowledge and caregiver confidence to support patient’s self­care. Three studies found that
multidisciplinary support sessions significantly reduced caregiver burden, depressive symptoms and increased
heart failure related knowledge. The majority of the interventions were provided immediately following
discharge, with one American study conducted with caregivers of patients in the advanced stages of heart
failure. Synthesis of the results identified four key areas of need: education on heart failure condition and
symptoms, strategies to help with daily self­care activities, appropriate information on patient’s health status and
knowing what to do in the case of an emergency.
Conclusions: The findings of this systematic review highlight that psycho­educational resources can effectively
improve the well­being of caregivers of heart failure patients. Nurses have a key role to play in the development
and provision of appropriate tailored education and support to both patients and their caregivers.