Heart disease can be a costly burden to many patients with the disorder. Ways to reduce expenses related to the condition are welcome. How can self-management reduce costs from heart disease? Jovicic and colleagues examined the impact of self-management interventions on hospital readmission rates, mortality, and quality of life in patients diagnosed with heart failure. The investigation reviewed and analyzed controlled trials conducted on the topic. These studies were located by looking at a number of databases, reference lists, and by talking with experts in the fields. Included in the search were randomized controlled trials of self-management interventions with patients 18 years of age or older who were diagnosed with heart failure. The primary outcomes of interest were all-cause hospital readmissions, hospital readmissions due to heart failure, and mortality. Secondary outcomes were compliance with treatment and quality of life scores.

The authors found that of 671 identified citations, 6 randomized trials with 857 patients met their standards for the review. Self-management was found to decrease all-cause hospital readmissions and heart failure readmissions. The effect on mortality was not significant. Adherence to prescribed medical advice improved, but there was no significant difference in functional capabilities, symptom status, and quality of life. The reported savings, however, ranged from $1,300 to $7,515 per patient per year.

Comments: The authors concluded that self-management programs targeted for patients with heart failure decrease overall hospital readmissions and readmissions for heart failure. This was a major conclusion of the study. However, the results showed a dramatic reduction in the burden of health care costs to patients and health care programs. While this change seemingly did not increase the quality of life of patients, it undoubtedly brought some peace of mind to them and their families. The finding alone is cause enough for developing and promoting more self-management programs for patients with heart disease. As with all self-management programs applied to a chronic illness, there is also a need for long-term follow-up data.

A. Jovicic et al. Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. BMC Cardiovascular Disorders, 2006 6:43.