The Chronic Disease Self-Management Program (CDSMP) was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n=317) with twelve months of follow-up after the start of the program. That trial demonstrated short-term improvements in cardiac-specific quality of life. A study by Smeulders and colleagues assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life. Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life. In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROFESSIONAL: The authors concluded that subgroup effects were found for cognitive status and educational level. Future research, they continued, should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the program.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: If you believe you are less educated than others but as smart as others, the study should be encouraging. It not only suggests that you should participate in self-management programs, but that you can learn how to make a significant contribution to the control of a chronic condition.

ES Smeulders et al. Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme. Patient Education & Counseling, February 10, 2010.