. 2022 Aug 8;13:21501319221112584. doi: 10.1177/21501319221112584

Table 1.

Characteristics of the Included Studies.

Author Country	Purpose	Study design	Sample	Demographics data (mean ± SD) (%)	Instruments	Findings
Al-Rawashdeh et al²² USA	To determine whether sleep disturbances of patients and their spousal caregivers predicted their own and their partners’ QOL	CS	78	• Age 59.53 ± 12.3 years	• Beck depression inventory II (BDI-II)	• Patients’ mental well-being was sensitive to their spouses’ sleep disturbance.
				• Female (74.4)	• Minnesota living with heart failure	• Patients’ sleep disturbance was significantly correlated with spousal caregivers’ mental well-being (P < .01).
				• High school (50)	• PHQ-9	• Sleep disturbance scores were negatively correlated with age in spouses (r = −.220, (P = .05)
				• Chronic disease (81.9)	• Restfulness of sleep
				• Chronic disease (81.9)	• QOL
Bahrami et al⁴⁵ Iran	To explore the Iranian family caregivers’ burden of caregiving for patients with HF	QS	18	• Age 31-50 years (77.78)	• In-depth understanding of the experiences of caregiving for HF patient and challenges in the caregiving situation	• Four major themes emerged from the analysis of the transcripts: Lack of care-related knowledge, physical exhaustion, psychosocial exhaustion, and lack of support.
				• Female (77.8)		• Family caregivers believed that they have little knowledge about the patients’ disease, drugs, and how to perform caregiving roles.
				• Married (66.67)		• CGs experienced negative physical and psychosocial consequences of full-time and highly extended caregiving roles, such as musculoskeletal disorder, fatigue, and sleep disturbance, and a high level of anxiety, stress, and social isolation
				• Patient’s daughter (38.89)		• CGs believed that they receive little familial and organizational support on the emotional and financial dimensions of caregiving.
				• Primary school (50)
				• Homemaker (61.11)
				• Monthly family income <US$200 (61.11)
				• Providing care >6 h/day (77.78)
Bangerter et al⁴⁷ USA	To examine the predictors of self-gain and gain a holistic, in-depth understanding of the challenging and positive aspects of caring for a person with HF.	MS	108 (CS)	• Age 65.9 ± 13.5 years	Quantitative data:	Quantitative results: • Spouse caregivers had 3.3 times higher odds of high self-gain compared with non-spouse caregivers (95% CI 1.15-9.48, P = .023).
			16 (QS)	• Female (83.8)	• Caregiver self-gain	• Caregivers with higher preparedness had 1.12 times greater odds of high self-gain (95% CI 1.03-1.21, P = .003).
				• Some college (37)	• Caregiver mastery scale	• Caregivers with higher mastery had 1.16 times greater odds of high self-gain for caregiver age and sex (95% CI 1.00-1.35, p = 0.045).
				• Married (63.9)	• Caregiver preparedness scale	Qualitative data: authors revealed three themes of self-gain including: (1) caregiving as a means to enhancing relationships, (2) success in negotiating care and healthy behaviors with patients with HF, (3) caregiving as a means of preparing caregivers for the future.
				• Retired (48.8)	• Zarit Burden inventory (ZBI)
				• Providing care <1 year (40.6)	• Health literacy marital satisfaction
				• Spousal caregiver (32.5)	Qualitative data:
				• Spousal caregiver (32.5)	• In-depth understanding of the challenging and positive aspects of caring for a person with HF
Bidwell et al²³ USA	To quantify the influence of patient and caregiver characteristics on patient clinical event risk rehospitalization or death) in HF	CS	183	• Age 57.2 ± 14.3 years	• Caregiver burden inventory (CBI)	• Higher caregiver strain had a 0.94 times lower risk of clinical event (95% CI 0.91-0.97, P < .001).
				• Female (67.3)	• Caregiver mental health status	• Higher mental health status of caregiver had 0.41 times lower risk of clinical event (95% CI 0.20-0.84, P = .01).
				• High school (51.2)	• Caregiver contributions (CC-SCHFI)	• Greater caregiver contributions to HF self-care maintenance had 0.99 times lower risk of clinical event (95% CI 0.97-0.99, P = .04).
				• Spousal caregiver (32.5)	• Caregiver contributions (CC-SCHFI)	• Greater caregiver contributions to patient self-care management had 1.01 times higher risk of clinical event (95% CI 1.00-1.03, P = .04).
Chiang et al⁴⁶ Taiwan	To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family CG burden, stress mastery and family function in family CGs of HF patients compared to those receiving traditional discharge planning only.	QE	30	• Age >60 years (50)	• The Chinese version of the caregiver burden inventory (CBI)	• Family CGs in both groups had significantly lower burden, higher stress mastery, and better family function at 1-month follow-up compared to before discharge
				• Female (76.7)	• The mastery of stress scale	• The total score of CG burden, stress mastery, and family function were significantly more improved for the family CGs in the experimental group than the comparison group at post-test.
				• Bachelor’s degree (53.4)	• The Chinese version of the Feetham family functioning survey
				• Married (86.7)
				• Total household income ≤US$1670-6250 (45)
				• Spousal caregiver (50)
				• Employed (60)
				Caregiving time 1-5 years (53.3)
Cooney et al²⁴ USA	To test the moderating role of changes in caregivers’ social support and patient-caregiver relationship mutuality in the association between HF patient functioning and caregiver burden	CS	100	• Age 57.22 ± 15.66 years	• ZBI	• The reduction in caregiver-patient mutuality over the 12 months of the study amplified the association between patient functioning (ie, dyspnea, symptom severity, and disability) and caregiver burden.
				• Female (81)	• The ENRICHD social support scale	• Caregiver burden at wave 1 correlated with patient disability at wave 2 P < .05
				• Married (60)	• Family caregiving inventory
				• Relationship with the patient; child (26)	• Family caregiving inventory
Davidson et al²⁵ Australia	To describe the profile of those providing care in the community and their needs.	CS	373	• Age 31-50 years (77.78)	• Index of socioeconomic disadvantage (SEIFA) index	• Two factors were significant predictors of unmet needs at the time of death which related to caregiver burden compared between caregivers for people with HF and caregivers for people with other diagnoses. First, the increase a year of age (OR 1.02; 95% CI 1.01-1.04; P = .005) and not having access to palliative care services (OR 0.39; 95% CI 0.24-0.64; P = .000).
				• Female (77.8)
				• Married (66.67)
				• Patient’s daughter (38.89)
				• Primary school (50)
				• Homemaker (61.11)
				• Monthly family income <US$200 (61.11)
				• Providing care >6 h/day (77.78)
Dirikkan et al¹⁵ Turkey	To evaluate the relationship between the caregiver burden and the psycho-social adjustment of caregivers to cardiac failure patients	CS	200	Completed primary school (37.5)	• ZBI	• 94% of the caregivers remarked that after the diagnosis they experienced physical, psychological, social, occupational, or economic changes.
				• Retired (24.0)	• The psychosocial adjustment to illness scale (PAIS-SR)	• 71.5% of caregivers faced difficulties with care provision, and 84% experienced the anxiety.
				• Spousal caregiver (43)	• The psychosocial adjustment to illness scale (PAIS-SR)	• Caregiver burden were statistically significant relationships with psychosocial adjustment to illness subscale including vocational environment (r = .484); domestic environment (r = .416); sexual relationship (r = .210); extended family relationships (r = .182); social environment (r = .365); psychological distress (r = .493).
Durante et al⁴ Italy	To identify predictors of caregiver burden in heart failure; and to evaluate if caregiver contribution to heart failure self-care maintenance and management increases caregiver burden.	CS	505	• Age 56.5 ± 14.9 years	• CBI	• The only two predictors of higher developmental burden were patients taking fewer medications, and lower patient mental QOL (F = 2.994, P < .001).
				• High school (51.7)	• CC-SCHFI)	• Higher levels of physical burden were significantly associated with caregiver older age, fewer medications taken by the patient and lower patient mental QOL (F = 2.534, P < .001).
				• Married (72.5)	• Social support received by the caregiver	• Higher levels of social burden were significantly associated with caregivers’ older age, fewer hours of caregiving per day, lower levels of caregiver social support, lower caregiver physical and mental QOL, higher patient education, fewer medications taken by the patient and lower patient mental QOL (F = 4.678, P < .001)
				• Currently employed (56)		• Higher levels of emotional burden were significantly associated with fewer hours of caregiving per day, older patient age, higher patient education, fewer medications taken by the patient, higher level of patient physical QOL and lower patient mental QOL (F = 5.108, P < .001).
				• Hours of caregiving per day (7.5 ± 7.1)		• Higher levels of total burden were significantly associated with caregivers’ older age, patient older age, higher patient education, and lower patient mental QOL (F = 3.590, P < .001).
				• Relationship with the patient; child (49.3)
Durante et al⁵ Italy	To describe CG contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur).	QE	40	• Age 53.6 ± 15.66 years	• Elicit in-depth descriptions of how caregivers contributed to the self-care of the patients	• Caregiver contributions to self-care maintenance included practices related to: (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, (4) reinforcing dietary restrictions
				• Female (82.5)		• Caregiver contributions to self-care management included practices related to: (1) symptom recognition, (2) treatment implementation
				• High school (52)		• Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic)
				• Married (80)
				• Employed (52.5)
Ghasemi et al²⁶ Iran	To investigate the relationship between caregivers burden and family functioning in family caregivers of older adults with HF	CS	140	• Age 38.74 ± 12.77 years	• ZBI	• A direct correlation between mean score of care burden and total score of family functioning (r = .345, P = .047).
				• Female (61.9)	• Family assessment device	• A direct relationship between the score of burden of care and the dimensions of problem solving (r = .206, P = .032) and affective responsiveness (r = .115, P = .045).
				• Married (79)		• Caregivers of HF patients with chronic disease had higher burden scores than caregivers of HF without chronic disease (t = 2.76, P = .007) and older age (r = .257, P = .007).
				• Bachelor’s or higher degree (37.7)
				• Employed (50)
				• Monthly income US$237.5 (44.2)
				• Average care rate 5-8 h/day (31.4)
				• Affected by a chronic disease themselves (48)
				• Relationship with the patient; child (49.29)
				• No chronic disease (65)
Grant et al²⁷ USA	To examine predictors that influence depressive symptoms in informal caregivers of IHF.	CS	530	• Age 41.39 ± 10.38 years	• Social support	• 57.7% of caregivers were experiencing depressive symptoms
				• Married (92.3)	• Social problem-solving	• Caregivers who provided care for 3-4 years had 2.9 times higher odds of depression than caregivers who have provided care for 6 months to 1 year (95% CI = 1.02-8.60, P < .05).
				• Spousal caregiver (44.9)	• Family functioning	• Rural caregivers had 2 times higher odds of depression than caregivers in urban areas (95% CI = 1.03-3.88, P < .05).
					• CBI	• Odds of depression decreased 1.28 times with each 1 unit increased in social support (95% CI = 1.21-1.37, P < 0.05).
					• Depressive symptoms	• Odds of depression decreased 1.20 times with each 1 unit increased in social problem-solving (95% CI = 1.07-1.36, P < .05).
Graven et al²⁸ USA	To examine whether social support and problem-solving mediate relationships among caregiver demands and burden, self-care, and life changes in HF caregivers.	CS	530	• Age 41.39 ± 10.38 years	• Dutch objective burden inventory	• Social support may be a relevant mediator of the relationship between caregiver burden and depression (indirect effect = 0.25), with increases in social support associated with decreased depression.
				• Female (49.1)	• Interpersonal support evaluation	• Increased caregiver burden is associated with worse caregiver self-care, more depression, and negative perceptions of life changes due to caregiving.
				• Married (92.5)	• Social problem-solving inventory	• Clinicians should assess caregivers’ available support and make appropriate referrals to community services and resources.
				• Bachelor’s degree (54.9)	• The center for epidemiological studies-depression scale
				• Spousal caregiver (44.9)	• Denyes self-care practice
				• Length of time providing care; 1-2 years (40.9)	• Bakas caregiving outcomes scale
Hooker et al²⁹ USA	To examines the associations among mutuality, patient self-care confidence and maintenance, caregiver confidence in and maintenance of patient care, and caregiver perceived burden.	CS	99	• Age 57.4 ± 15.8 years	• ZBI	• Patients and caregiver’s mutuality increased the confidence in-patient self-care (P < .05).
				• Female (80.8)	• Mutuality scale of FCI	• Regression models indicated that caregivers with greater mutuality reported less perceived burden P < .01).
				• High school (36)	• Caregiver contributions self-care of heart failure index (CC-SCHFI)	• Perceived caregiver burden was also significantly and negatively associated with caregiver confidence in patient self-care (b = −.76, SE = 0.25, β = −.29, P = .003)
				• Retired (32)
				• Married (82)
				• Total household income ≤US$40,000 (45)
				• Spousal caregiver (60)
				• Providing care >8 h/day (58)
Hu et al³⁰ China	To investigate the status of caregiver burden and identified the factors related to caregiver burden among family caregivers of patients with HF	CS	226	• Age 41.9 ± 13.8 years	• ZBI	• The mean ZBI score was 37.1 (SD = 12.3)
				• Female (57.6)	• Social support rating scale	• 86.7% of caregivers perceived a high level of burden.
				• Married (75.8)	• General self-efficacy scale	• The caregiver burden was inversely associated with social support (r = −.527, P < .01) and self-efficacy (r = −.509, P < .01).
				• Junior high school or above (71.2)		• The payment type for treatment (b = −.431, P < .01), monthly family income (b = −.133, P < .01), relationship to the patient (b = .404, P < .01), self-efficacy (b = −.314, P < .01), and social support (b = −.137, P < .01) were significantly related to the caregiver burden.
				• Monthly family income <US$500 (82.8)
				• Spent >4 h/day providing care for the patients (84.1)
				• Cared for the patients >1 year (47.8)
Hu et al⁴⁰ China	To examine the effects of the multidisciplinary supportive program on caregiver burden, QOL, and depression.	RCT	118	• <40 years (58.5)	• ZBI	• Intervention consisted of: (1) health education; (2) peer support group; and (3) regular follow-up and consultations
				• Female (57.6)	• HRQOL SF-36	• There were significant improvements in caregiver burden (F = 65.345, P < .001), mental component of QOL (F = 22.482, P < .001), and depression (81.589, P < .001) after post-test and 3 months after post-test in the experimental group.
				• Married (83.1).	• Center for epidemiologic studies depression scale (CES-D)	• The physical component of QOL did not improve after the intervention.
				- Senior high school (32.3)		• There was no significant improvement in caregivers’ physical health at either 3 or 6 month following discharge.
				• Employed (75.4)
				• Monthly family income <US$500 (82.2).
				• Taken care of the patients for >1 year (54.2)
				• Spent >4 h/day on caregiving (84.7)
Hu et al³¹ China	To investigate the QOL and to identify the factors (characteristics of patients and caregivers, caregiver burden, self-efficacy, and social support) related to QOL among family caregivers of patients with HF	CS	251	• <50 years (78.1)	• Social Support Rating Scale (SSRS)	• The median scores of physical and mental QOL were 70 and 60, respectively.
				• Female (58.2)	• ZBI	• NYHA classification (b = −.675, P < .01), caregiving h per day (b = −1.929, P < .01), number of readmissions (b = −.344 P < .01), caregiver burden (b = −.013, P < .05), social support (b = .039, P < .05), and self-efficacy (b = .217, P < .05) were associated with PCS.
				• Married (76.1)	• General self-efficacy scale (GSE)	• NYHA classification (b = −.700, P < .01), caregiving hours per day (b = −1.608, P < .01), number of readmissions (b = −.362, P < .01), caregiver burden (b = −.015, P < .05), and social support (b = .039, P < .05) were significantly associated with MCS.
				• Junior high school education or higher (71.7)	• HRQOL SF-36.
				• Monthly family income <US$500 (82.9)
				• Unemployed while taking care of patients (52.6)
				• Spent >4 h/day providing care (75.3)
				• Cared for the patients >1 year (47.8%)
Hu et al³² China	To investigate the status of depressive symptoms and to identify the factors that are associated with depressive symptoms in family care-givers of patients with HF	CS	134	• Age 41.4 ± 13.6 years	• ZBI	• 31% of the caregivers experienced depressive symptoms.
				• Female (58.2)	• Caregivers’ Depressive symptoms (the CES-D scale)	• The type of payment for treatment (b = −.312, P < .01), readmissions within the last 3 months (b = .397, P < .01), duration of caregiving (b = −.213, P < .05), caregiver burden (b = .299, P < .05), active coping (b = −.235, P < .01), and negative coping (b = .245, P < .05) were related to caregivers’ depressive symptoms.
				• Married (83.6)	• Coping ability (the 20-item SCSQ)
				• Equivalent to junior high school or below (58.2)
				• Monthly family income <US$500 (82.8)
				• Spousal caregivers accounted for 29.1% of the sample
				• Unemployed (61.9)
				• Spent >4 h./day caregiving (84.3)
				• Provided care to the patient >1 year (53)
Hwang et al³³ USA	To identify factors associated with the impact of caregiving	CS	76	• Age 53.4 ± 15.7 years	• Dutch objective burden inventory	• Impact on finances was related to CGs’ economic status, perceived control, and social support. Although caregivers’ economic status (β = −.43; P < .001) explained a considerable amount of variance in the financial strain (16%), CGs’ perceived control (β = −.24; P = .01) and the availability of social support (β = −.26; P = .01)
				• Female (54)	• The medical outcome study social support survey	• Impact on schedule was associated with patient’s NYHA class (β = .27; P = .003), amount of care tasks performed (β = .43; P < .001), CG’s perceived social support (β = −.37; P < .001)
				• High school (33.5)	• The control attitudes scale-revised	• CG’s esteem was associated with CGs perceived social support and the patient’s comorbid conditions (β = 1.57; P = .01), nonwhite caregivers felt more positive about their role as a CG than did white CGs (β = .29; P = .006). The more often a patient had visited the emergency department in the preceding 12 months, the less positive CGs felt about their role as a CG (β = −.25; P = .02).
				• Married (54)	• The caregiver reaction assessment (CRA)
				• Total household income ≤US$1670-6250 (45)	• The physical and mental component summary scores of the short form 36 health survey
				• Spousal caregiver (56)	• The patient health questionnaire (PHQ-8)
				• Employed (41)
				• Providing care >7 h/day (64)
Jackson et al³⁴ China	To describe the burden of caregiving on informal caregivers of patients with chronic HF	CS	458	• Age 60.1 ± 10.6 years	• Caregiver self-completion (CSC)	• Time spent and activity: caregivers were most often required to provide support included reminding patients to take their medication (70%), helping patients prepare meals (65%), and providing emotional support and encouragement (59%).
				• Female (60)	• EuroQol (EQ-5D-3L)	• Social life and employment: 63% of caregivers reported that caregiving had resulted in changes to some aspects of their lives such as reduction in their social activities (33%), followed by reductions in time for themselves (21%) and time for their other family members (12%).
				• Retired or pensioners (74)	• HF caregiver questionnaire (HF-CQ)	• Caregivers’ own health: 57% of the caregivers reported that caregiving had negatively affected their health in some way such as stress (23%), anxiety (23%), sleeping problems (14%), migraines/headaches (9%), and depression (7%).
				• Full-time employment (16)		• QOL: 79%-99% reported that HF had no impact on QOL
				• Commonly spouses (77) or a son/daughter (20).		• Economic burden: 22% reported that a change in their job or a reduction in working hours had resulted in a decrease in income. (95%) were not receiving financial support from the health care system or social services
				• Spent time taking care of the patients 24.5 ± 16.9 h/week
Lee et al³⁵ USA	To examined whether HF patients with depression received assistance from CPs living outside of their homes	CS	372	• Age 47 ± 13.20 years	• Care partners support	• Depression was not significantly associated with caregiving strain (IRR 1.00, 95% CI 0.81: 1.23, P = .984).
				• Female (64.4)	• Modified caregiver strain index (MCSI))	• CPs who provided greater in-person support h per week had significantly greater MCSI scores (IRR = 1.03, 95% CI 1.01-1.06, P = .008). However, CPs’ weekly telephone support hours were not significantly associated with their MCSI scores (IRR = 1.02, 95% CI 0.98-1.06, P = .341).
				• Married (69.9)		• Patient depression had no effect on caregiver burden (IRR = 1.00, P = .843).
				• Employed (63.1)
				• At least some college education (73.1)
				• CPs were most commonly the adult child of their support recipient (61.8)
Leung et al³⁶ China	To examined whether support from family and friends would associate with caregiver burden and patient’s QOL to different extents, mediated via caregiving self-efficacy in patient–caregiver dyads with patients requiring palliative care using a structural equation modeling approach.	CS	225	• Age 57.1 ± 14.6 years	• Caregiver burden Chinese version (C-CGI-18)	• The final model provided a satisfactory fit (SRMR = 0.070, R-RMSEA = 0.055 and R-CFI = 0.926) with the data, as good as the hypothesized model did (P = .326).
				• Females (64.9)	• Chinese version of the multidimensional scale of perceived social support (C-MSPSS)	• Family support had a significant negative indirect effect on caregiver burden and a significant positive indirect effect on patient’s QOL through caregiving self-efficacy, whereas friend support had a significant positive direct effect on caregiver burden but a minimal effect, if any, on a patient’s QOL.
				• Married (83.1)
				• Secondary education or above (68.4)
				• Relationship with the patient (child) 51.6
				• Perceived health status 3.28 ± 0.97
				• Had a domestic helper (25.3)
Liljeroos et al⁴¹ Sweden	To describe the 24 month effects from a psycho-educational intervention in relation to caregiver burden and morbidity in partners to HF patients	RCT	155	• Age 67.1 ± 12.1 years	• CBI	• A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time.
				• Females (75)	• QOL (SF-36)	Intervention: consisted of: face-to-face counseling; educational booklets; and computer programs.
				• Retired (68)	• Beck depression inventory II (BDI-II)	• The intervention focused on help partners develop problem- solving skills to be able to recognize and alter factors contributing to emotional and psychological stress.
				• Exercised >3 h/week (50)	• Control attitude scale (CAS)	• The mean total caregiver burden in both groups was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, P = .05).
				• Exercised >3 h/week (50)	• Control attitude scale (CAS)	• There were no significant differences between the intervention and control group in any dimension of caregiver burden after 24 months
Malik et al³⁷ UK	To compare experiences of caring for a breathless patient with lung cancer versus those with heart failure and to examine factors associated with CG burden and positive caring experiences	CS	51	• Age 65.8 ± 12.7 years	• The modified Borg breathlessness scale	• Higher burden was associated with poorer “quality of patient care” and worse CGs’ psychological health (R² = 0.37, F = 12.2, P = .01)
				• Female (82)	• ZBI	• Caregiver depression and looking after more breathless patients were associated with fewer positive caring experiences (R² = 0.15, F = 4.4, P = .04).
				• Married (86.7)	• Hospital anxiety and depression scale
				• Spousal caregiver (70)	• Short form-36 (SF-36)
				• Employed (82)	• Short form-36 (SF-36)
Metin and Helvacı³⁸ Turkey	To examine the correlation between quality of life, depression, anxiety, stress, and spiritual well-being in patients with heart failure and their family caregivers	CS	60	• Age 52.0 ± 13.5 years	• FCI	• QOL was negatively associated with depression (r = −.808, P < .05).
				• Females (25.0)	• Depression anxiety stress scale (DASS)	• QOL was positively correlated with spiritual well-being (r = .548, P < .05).
				• Primary school (80)	• FACIT–Sp	• Depression was negatively associated with spiritual well-being (r = −.640, P < .05).
				• Married (100.0)	• WHOQOL-BREF	• QOL was associated with health status and spiritual well-being respectively (r = .434, r = .575, P < .05)
				• Income levels (moderate) (85.0)		• Depression was negatively correlated with health status and spiritual well-being respectively (r = −.390, r = −.513, P < .05).
				• Employed (81.7)
				• Relationship (Spouse) (53.3)
				• Duration of caregiving ≤5 years (75)
				• Daily caregiving time >8 h. (40.0)
Ng and Wong⁴² China	To examine the effect of a home-based palliative heart failure (HPHF) program on QOL, symptoms burden, functional status, patient satisfaction, and caregiver burden among patients with ESHF	RCT	84	• Age 78.3 ± 16.8 years	• ZBI	• The structure of the HPHF program included post discharge home visits and telephone calls.
				• Females (56.1)	• QOL	• A statistically significant between-group effect was found, with the HPHF group having significantly higher QOL total score than the control group (P = .016) and there was significant group × time interaction effect (P = .032).
				• No schooling (44.2)		• QOL: there were significant improvements over time.in the physical (P = .011), psychological (P = .04), and existential (P = .027) domains between the intervention and control groups.
				• Retired (97.7)		• Caregiver burden: a significant difference was noted between the intervention and control groups at 4 weeks in the aspects of dyspnea (P = .02), emotional function (P = .014), mastery (P = .019), and the total score (P = .01).
				• Perceived economic status (just enough) (58.1)		• Caregiver burden: there was no between-group effect noted at 12 weeks for any group.
Piamjariyakul et al⁴³ USA	To improve family caregiver outcomes	RCT	20	• Age 61.4 ± 15.7 years	• Preparedness scale	• At 6 months, compared to standard care, the intervention group had significantly fewer rehospitalizations (P = .03), higher caregiver confidence (P = .003) and higher social support (P = .01) were significantly higher, and lower caregiver depression (P = .01) than control. While preparedness on HF home care and caregiver burden were not statistically significant differences.
				• Female (85)	• Perceived social support
				• High school (60)	• CBI
				• Married (70)	• The center for epidemiologic studies depression scale (CES-D)
				• Employed (60)	• Helpfulness rating
Timonet-Andreu et al⁴⁸ Spain	To analyze the relationship between HF patients’ use of hospital services and the HRQOL of their family caregivers.	MCS	530	• Age 56.3 ± 14.3 years	• Caregiver Strain Index (CSI)	• Patients’ use of hospital services was associated with worsened QOL for family caregivers, with an overall OR of 1.48 (95% CI: 1.23-1.79, P < .001).
				• Female (77.4)	• PHQ-9	• A positive correlation was found between patients’ perceptions of their physical health and the perceived mental health of caregivers (r = .127, P = .004) and between the perceived mental health of both (r = .291; P < .001).
				• Primary school (62.6)	• HRQOL
				• Relationship with patient; child (50.9)	• HRQOL
Vellone et al⁴⁴ Italy	To evaluate the influence of mutuality as a whole and of its dimensions on self-care maintenance, management, and confidence in HF patient caregiver dyads	RCT	366	• Age 58.61 ± 15.66 years	• Mutuality scale	• There is also evidence of actor effects of patient and caregiver mutuality on patient self-care confidence (B = 4.144, P = .039) and on caregiver self-care confidence (B = 9.209, P < .001).
				• Female (73.3)	• Caregiver contribution to self-care of heart failure index	• The only partner effect that we found was the effect of patient mutuality total score on caregiver contribution to self-care management (B = 5.756, P = .014).
				• Married (69.6)		• Total score of patient mutuality also had a partner effect on caregiver self-care management (ie, responses to symptoms of HF exacerbation).
				• Unemployed or retired (53.44)
				• High school (37.5)
				• Relationship with patient; child (43.5)
Yeh and Bull³⁹ USA	To examine the influences of older peoples’ activities of daily living dependency, family CGs’ spiritual well-being, quality of relationship, family support, coping, and care continuity on the burden of family CGs of hospitalized older people with CHF using the Resiliency Model of Family Stress, Adjustment, and Adaptation.	CS	50	• Age 60.33 ± 14.42 years	• JAREL spiritual well-being scale (SWBS)	• Patients’ ADL dependence, spiritual well-being, coping, quality of relationships, lack of family support, and care continuity accounted for 66% of the variance in family CG burden.
				• Female (70)	• Carers’ assessments of managing index (CAMI)
				• High school (58)	• Care continuity scale
				• Monthly income > US$ 2000 (48)	• Caregiver reaction assessment (CRA)
				• Married (86.7)	• Caregiver’s esteem subscale
				• Spousal caregiver (40)	• Lack of family support subscale
				• Employed (82)	• Index of ADL
				• Length of time in the caregiver role >1 year (68)
				• Providing care >6 months (80)

Abbreviations: CBI, caregiver burden inventory; CG, caregiver; CPs, caregiver partners; CS, cross-sectional study; FACIT–Sp, functional assessment of chronic illness therapy–spiritual well-being scale; FCI, family caregiving inventory; HF, heart failure; HRQOL, health-related quality of life; MCS, multicenter case-control study; MS, mixed-methods study; PHQ-9, the patient health questionnaire 9-it; QE, quasi-experimental study; QOL, quality of life scale; QS, qualitative study; RCT, randomized controlled trial study; WHOQOL-BREF, the world health organization quality of life short form; ZBI, Zarit Burden Inventory.