Table 1.

Description of nurse-led CVD self-care interventions.

Study and location	Sample (as reported)	Intervention/control	Primary outcomes and measurement	Key findings
Albert et al. (2007); USA [18]	N = 112 Gender: males n = 86 Ethnicity: Caucasian n = 93 CVD diagnosis: HF Attrition not reported	IG: multimedia (video education) CG: standard education by physician and/or nurse	Healthcare resource utilization: hospitalization, emergency care, office visits, and laboratory tests medical records Self-care/adherence: adapted from SCHFI Functional class: NYHA status change Timeframe: baseline, 3 m	(1) 3-month healthcare utilization (P = NS) (2) IG had greater sign/symptom recognition (P < .04) and higher mean self-care behavior/adherence (P < .01)
Artinian et al. (2003); USA [19]	N = 18 Gender: males n = 17 Ethnicity: Black n = 11 Caucasian n = 6 CVD diagnosis: HF Attrition not reported	IG: web-based monitoring CG: usual care	Self-care: HFSCBS Medication adherence: pill counts QOL: MLHF Timeframes: baseline, 3 months	(1) Improved QOL in IG (F = 10.0, P = .006), (P = .002); not CG (P = .113) (2) Better adherence in IG versus CG (P = NS)
Barnason et al. (2006); USA [20]	N = total 50 Gender: males n = 28 Ethnicity not reported CVD diagnosis: CHD Attrition not reported	IG: combined intervention of telemonitoring and home visit CG: usual care	QOL: SF-36 Healthcare utilization: emergency care Timeframe: baseline, 6 weeks, 3 m	(1) IG had higher QOL general health functioning (F = 8.41, P < .01) (2) Significant time effects in QOL physical (F = 9.42, P < .01), role-physical functioning (F = 5.74, P < .05) in both groups (3) CG had more ER visits (NS)
Barnason et al. (2009); USA [21]	N = 55 Gender: males n = 46 Ethnicity: White n = 54, nonwhite n = 1 CVD diagnosis: CHD Attrition not reported	IG: telehealth intervention CG: usual care	QOL: SF-36 Physical activity/energy expenditure: RT3 accelerometer Timeframe: baseline, 3 w, 6 w, 3 m, 6 m	(1) Significant main effect by group in energy expenditure/physical activity (F = 4.66, P < .05) (2) Both groups had significantly improved QOL P < .05)
Brandon et al. (2009); USA [22]	N = 20 Gender: males = 9 Ethnicity: Caucasian n = 8, African American n = 12 CVD diagnosis: HF Attrition not reported	IG: nurse-led telephone intervention (7 telephone calls, 5–30 minutes in length) CG: usual care with standard education by physician and/or nurse	QOL: MLHF Self-care: Self-Care Behavior scale Healthcare utilization: self-report hospitalizations Timeframe: baseline, 3 m	(1) IG improved self-care behaviors (F = 21.853, P < .001) and reduced hospital readmissions (F = 7.63, P = .013) (2) QOL in IG improved P = NS; no change in UC
Caldwell et al. (2005); USA [23]	N = 36 Gender: males n = 25 Ethnicity: white n = 34, other = 2 CVD diagnosis: HF Attrition n = 11	IG: combined intervention: focused education and counseling with telephone follow-up CG: usual care	Self-care: EHFScBS Biomarkers: BNP Timeframe: baseline, 3 m	(1) Self-care improved significantly in IG (P = .03) (2) No significant difference in BNP levels (P = .21)
DeBusk et al. (2004); USA [24]	N = 462 Gender: males n = 236 Ethnicity: white n = 386, Black n = 27, Hispanic n = 14, American Indian n = 27, Asian n = 8 CVD diagnosis: HF Attrition n = 72	IG: telephonic case management CG: usual care	Healthcare utilization: HF and all-cause hospitalizations medical claims Timeframe: baseline, 12 m	(1) HF rehospitalization similar in both groups (NS) (proportional hazard, 0.85 (95% CI = 0.46, 1.57)) (2) All-cause rehospitalization NS (proportional hazard, 0.98 (95% CI = 0.76, 1.27))
Dougherty et al. (2005); USA [25]	N = 168 Gender: males n = 139 Ethnicity: Caucasian n = 150, American Indian/Alaska n = 3, Asian/Pacific Islander n = 4 CVD diagnosis: arrhythmia Attrition n = 18	IG: combined intervention: self-care management patient education, telephone, and clinical support CG: usual care	QOL: SF-36 Depression: CES-D Healthcare utilization: outpatient visits, hospitalizations, and emergency care Timeframe: baseline, 6 m, 12 m	(1) Improved mood in IG (P = .04) compared to CG (2) No statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months
Gallagher et al. (2003); Australia [26]	N = 196 Gender: 196 females Ethnicity not reported CVD diagnosis: CHD Attrition not reported	IG: combined intervention: telephone intervention with behavioral focus CG: usual care	Depression: Hospital Anxiety and Depression Scale Timeframe: baseline, 12 w	(1) No significant differences in anxiety (F = 0.15, P = .69) or depression (F = 0.11, P = .74) between groups
Gould (2011); USA [27]	N = 154 Gender not reported Ethnicity not reported CVD diagnosis: CHD Attrition n = 25	IG: combined intervention: discharge nursing intervention with telephone follow up (IG, n = 64) CG: usual care	Adherence: Morisky adherence Healthcare utilization: urgent care Timeframe: baseline, 3 days	(1) No significant group differences were found on medication adherence, or use of urgent care
Harrison et al. (2002); Canada [28]	N = 192 Gender: males n = 105 Ethnicity not reported CVD diagnosis: HF Attrition n = 8	IG: combined intervention: transition/discharge care: educational materials, telephone, and home visits CG: usual care included home visits	QOL: MLHF, SF-36 Healthcare utilization: emergency care, readmission rates (medical records) Timeframe: baseline, 6 weeks, 12 weeks	(1) IG: improvement in QOL (27.2 ± 19.1) compared to the CG (37.5 ± 20.3; P = .002) (2) Less emergency room use in transitions group compared to CG (P = .03) but no change in readmission rates
Holmes-Rovner et al. (2008); USA [29]	N = 525 Gender: males n = 191 Ethnicity: Non-Hispanic white n-443, African American n = 60, Hispanic White n = 12 CVD diagnosis: CHD/acute coronary syndrome Attrition n = 152	IG: telephonic intervention with behavioral focus CG: usual care	Functional status/physical activity: Duke Activity Status Index BP Timeframe: baseline, 3 m, 8 m	(1) IG showed higher physical activity (OR = 1.53, P = .01) during the first three months (2) No significant differences in functional status or QOL
Jaarsma et al. (2000); the Netherlands [30]	N = 179 Gender: males n = 79 Ethnicity not reported CVD diagnosis: HF Attrition n = 47	IG: combined intervention of education, telephone, and home visits (6 encounters) CG: usual care	Self-Care: HFSCBS QOL: Cantril's Ladder Timeframe: baseline, 1 m, 3 m, 9 m	(1) Self-care behaviors improved in IG (1 m (t = 3.3, P < .001), 3 m (t = 2.9, P < .005) but not sustained at 9 m (t = 0.7, P = .47)) (2) QOL in both groups at 3 m not sustained at 9 m (3) Limited effect of self-care on QOL (r = 0.24, P < .05)
Kutzleb and Reiner (2006); USA [31]	N = 23 Gender: males = 8 Ethnicity not reported CVD diagnosis: HF Attrition not reported	IG: combined intervention: individualized education and counseling with telephone follow-up CG: usual care: protocol driven medical care	QOL: Ferrans and Powers QOL Index Functional status: 6-minute walk test Timeframe: baseline, 12 m	(1) IG: improved QOL (F = 3.569, P <.000) (2) IG: functional capacity NS (F = 0.228, P = .949) (3) Between-group NS
LaFramboise et al. (2003); USA [32]	N = 90 Gender: males = 45 Ethnicity: Caucasian n = 75, African American n = 12, other n = 3 CVD diagnosis: HF Attrition not reported	Combined intervention Group 1: Telephonic only Group 2: Home visit only Group 3: Telemonitoring Group 4: Home visit and Telemonitoring *All groups also received structured HF disease management 5 encounters	Functional status: 6-minute walk test Self-efficacy: BEES-HF Depression: Geriatric Depression Scale QOL: SF-36 Timeframe: baseline, 2 m:	(1) Group by time effect significant (P = .0027) in self-efficacy only (2) Improved functional status (P < .01), HRQL (P < .05), and depression (NS) in all groups
Lorig et al. (2003); USA [10]	N = 551 Gender: males n = 113 Ethnicity: U.S. born n = 31 Mexican born n = 353, Central American born n = 121, South American born n = 36 CVD diagnosis: CHD Attrition not reported	IG: group-based, peer-led community-based program CG: usual care	Healthcare utilization: emergency care, hospitalizations, Timeframe: baseline, 6 w, 4 m, 12 m	(1) IG had fewer emergency room visits (P < .05) at 4 m and 1 year (P < .001)
Maric et al. (2010); Canada [33]	N = 20 Gender: males n = 11 Ethnicity not reported CVD diagnosis: HF Attrition n = 3	IG: combined intervention: web-based education and monitoring with telephone follow-up CG: usual care	Self-care: SCHFI Functional status: 6-minute walk test Biomarkers-BNP Timeframe: baseline, 6 m	(1) Improved self-care (P = .039) (3) no change in QOL, (P = .337), 6-minute walk test (P = .124), and BNP (P = .210)
Mårtensson et al. (2005); Sweden [34]	N = 153 Gender: males n = 83 Ethnicity not reported CVD diagnosis: HF Attrition not reported	IG: combined intervention: individualized education and counseling with telephone follow up CG: usual care	QOL: MLHF, SF-36 Depression: Zung self-rated depression scale Timeframe: baseline, 3 m	(1) No significant difference in QOL; but IG preserved QOL while UC deteriorated in QOL (P = .035), vitality (P = .029) (2) No significant differences in depression
McKinley et al. (2008); Australia and USA [35]	N = 3522 Gender: males n = 2,393 Ethnicity: white n = 3,207, other n = 315 CVD diagnosis: CHD Attrition n = 386	IG: combined intervention: individual one-on-one education provided with structured education with counseling CG: usual care	Mood: Multiple Affect Adjective Check List Timeframe: baseline, 3 m, 12 m	(1) Knowledge increased significantly from baseline in IG compared to CG at 3 months and sustained at 12 months (P = .0005 for all) (2) Higher state anxiety was associated with lower levels of knowledge (P < .05)
Otsu and Moriyama (2009); Japan [36]	N = 96 Gender: males n = 61 Ethnicity not reported (Japanese study) CVD diagnosis: HF Attrition n = 3	IG: individualized (face-to-face) case management CG: usual care	QOL: Macnew health-related quality of life Functional status: NYHA Biomarkers; BNP Mortality: records Timeframe: baseline, 3 m, 6 m, 9 m, 12 m	(1) Statistically significant differences between groups: BNP at 3 m (P = .032) and 6 m (P = .002) (2) IG: improved QOL in IG improved (F = 26.157, P < .000) (3) No significant difference in NYHA but deterioration in symptom in the UC group (NS)
Paradis et al. (2010); Canada [37]	N = 30 Gender: males n = 22 Ethnicity not reported CVD diagnosis: HF Attrition n = 5	IG: combined intervention: motivational interview (3 encounters—1 in person; 2 telephone) CG: usual care	Self-care: SCHFI Timeframe: baseline, 1 m	(1) No significant results in self-care behaviors (2) IG: improved self-care confidence (P = .005)
Prasun et al. (2005); USA [38]	N = 66 Gender: males n = 43 4) Ethnicity: white n = 58, African American n = 7, other n = 1 CVD diagnosis: HF Attrition not reported	IG: supportive education about flexible diuretic titration CG: usual care	QOL: MLHF Functional status: 6-minute walk test Biomarkers: BNP, norepinephrine Healthcare utilization: emergency care, hospitalizations, mortality Timeframe: baseline, 3 m	(1) IG: improved 6-minute walk test (646 ± 60 ft versus 761 ± 61 ft, P = .01) and total QOL score (53 ± 5 versus 38 ± 5, P = .001), no change in CG group (2) Significantly fewer emergency care in the IG compared to CG (3% versus 23%, P = .015) (3) No differences in hospitalizations or mortality (4) No differences were found between baseline and 3-month biomarkers
Riegel et al. (2006); USA [39]	N = 134 Gender: males n = 62 Ethnicity: Hispanics n = 134 (109 Spanish-speaking) CVD diagnosis: HF	IG: telephonic case management with self-care education CG: usual care	Self-care: SCHFI Depression: Patient Health Questionnaire-9 Healthcare utilization: hospitalizations, cost, mortality—medical records Timeframe: baseline, 3 m, 6 m	(1) No significant group differences were found in HF readmission rate, HF days in the hospital, HF cost of care, all-cause hospitalizations or cost, mortality, or depression
Scott et al. (2004); USA [40]	N = 88 Gender: males n = 39 Ethnicity not reported CVD diagnosis: HF Attrition n = 22	Group 1: individualized counseling and usual care Group 2: supportive-educative and usual care Group 3: usual care and placebo	QOL: SF-36 Depression: Mental Health Inventory Timeframe: baseline, 6 m	(1) IG (groups 1 and 2) improved QOL (F = 4.632, P = .01) and depression (F = 6.27, P = .003) and over a 6-month period (2) between-group comparisons (NS)
Sethares and Elliott (2004); USA [41]	N = 70 Gender: males n = 33 Ethnicity: white n = 63, black n = 6 CVD diagnosis: HF Attrition n = 18	IG: combined intervention, individualized/tailored message intervention CG: usual care	QOL: MLHF Healthcare utilization: hospitalizations Timeframe: baseline, 1 w, 1 m	(1) No significant differences in HF readmission rates or QOL
Shearer (2007); USA [42]	N = 90 Gender: males n = 56 Ethnicity: white n = 81, black n-2, Hispanic n = 3, Native American n = 1 CVD diagnosis: HF Attrition n = 3	IG: telephonic intervention with behavioral focus CG: usual care	Self-care: self-management heart failure QOL: SF-36 Timeframe: baseline, 3 m	(1) IG improved self-care compared to CG (F = 6.19, P < .001) (2) QOL NS
Shively et al. (2005); USA [43]	N = 116, Gender: males n = 110 Ethnicity: Caucasian n = 87, African American n = 11, Hispanic n = 9, Asian/Pacific Islander n = 6, mixed n = 3 CVD diagnosis: HF Attrition = 15	IG: combined intervention: behavioral management with telephone follow up CG: usual care	QOL: SF-36, MLHF Functional status/exercise capacity: 6-minute walk test Timeframe: baseline, 4 m, 10 m, 16 m	(1) IG improved QOL compared to UG (F = 7.04, P = .009) (2) No group differences in exercise capacity
Smeulders et al. (2010); the Netherlands [44]	N = 317 Gender: males n = 230 Ethnicity not reported CVD diagnosis: HF Attrition n = 42	IG: group-based structured education CG: usual care	Self-care: EHFScBS QOL: SF36, Kansas City Cardiomyopathy Questionnaire Depression: HADS Timeframe: baseline, 26 weeks, 52 weeks	(1) IG improved in self-care (P < .01) and QOL (P = .005) (2) results not sustained at 6 and 12 months
Sol et al. (2010); the Netherlands [45]	N = 314 Gender: male n = 242 Ethnicity not reported CVD diagnosis: vascular disease Attrition n = 91	IG: tailored behavioral self-care intervention CG: usual care	QOL: SF-36 Biomarkers: lipids, BP, waist circumference, BMI Timeframe: baseline, 1 yr	(1) IG achieved treatment goals for LDL-cholesterol (difference 13%, 95% CI = 1, 26) and HDL-cholesterol (difference 9%, 95% CI = 0, 19) compared to CG (2) Mean SBP decreased significantly by 5 mm Hg (95% CI = −9, 0) in IG (3) BMI increased significantly by 0.4 kg/m2 (95% CI = −0.8, −0.1) in CG (4) No significant differences were seen in waist circumference, smoking, or triglycerides or QOL
Stafford and Berra (2007); USA [50]	N = 419 Gender not reported Ethnicity not reported CVD diagnosis: CHD Attrition n = 122	IG: combined intervention: individualized case management with follow-up meetings, telephone call, home visits CG: primary care	Framingham risk score Timeframe: baseline, 17 m	(1) IG had statistically significant reduction in mean Framingham risk probability compared to CG (1.6% decrease in 10-year CHD risk, P = .007)
Strömberg et al. (2003); Sweden [47]	N = 106 Gender: males n = 65 Ethnicity not reported CVD diagnosis: HF Attrition n = 43	IG: combined intervention: group based intervention focused on self-care education and support to patient and family CG: usual care	Self-care: HFSCBS Healthcare utilization: hospitalizations, length of stay, mortality Timeframe: baseline, 12 m	(1) IG: fewer patients with events (death or admission) after 12 months compared to CG (29 versus 40, P = .03) and fewer deaths after 12 months (7 versus 20, P = .005) (2) IG had fewer admissions (33 versus 56, P = .047) and days in hospital (350 versus 592, P = .045) during the first 3 months (3) At 12 months, there was a 55% decrease in admissions/patient/month (0.18 versus 0.40, P = .06) and fewer days in hospital/patient/month (1.4 versus 3.9, P = .02) (4) IG improved in self-care at 3 and 12 months compared to CG (P = .02 and P = .01)
Strömberg et al. (2006); Sweden [48]	N = 154 Gender: males n = 109 Ethnicity not reported CVD diagnosis: HF Attrition n = 24	IG: multimedia intervention CG: usual care	QOL: EuroQol Adherence: study-specific survey Timeframe: baseline, 1 m, 6 m	(1) NS difference between groups in adherence or QOL
Tonstad et al. (2007); Norway [49]	N = 51 Gender: males n = 36 Ethnicity not reported CVD diagnosis: hypertension Attrition n = 4	IG: combined intervention: behavioral intervention with telephone follow up focuses on lifestyle counseling CG: primary care	Biomarkers: lipids, triglycerides BP, Waist circumference  Timeframe: baseline, 6 m	(1) Waist circumference increased significantly between baseline and 6 m in CG but not in IG (mean difference 3.1 cm (95% CI 1.2–5.0), P = .04) (2) Reduced serum triglyceride in IG compared with CG (mean difference 0.56 mmol/L (95% CI 0.22–0.90), P = .03)
Westlake et al. (2007); USA [46]	N = 80 Gender: males n = 57 Ethnicity: white n = 58, black n = 8, Hispanic n = 3 other n = 11 CVD diagnosis: HF Attrition not reported	IG: web-based education (n = 40) CG: standard education	QOL: SF-36 Timeframe: baseline, 3 m	(1) Between-group improvement in QOL (P < .001)

BMI: body mass index; BNP: B-Natriuretic Peptide; BP: blood pressure; CG: control group; CHD: coronary heart disease; CVD: cardiovascular disease; EHFScBS: European Heart Failure Self-Care Behavior Scale; HF: heart failure; HFSCBS: Heart Failure Self-Care Behavior Scale IG: intervention group; MLHF: Minnesota Living with Heart Failure Questionnaire; NS: not significant; NYHA: New York Heart Association; QOL: quality of life; SCHFI: Self-Care of Heart Failure Index.