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 effectiveresources that are tailored to meet the needs of caregivers.Purpose: To assess how effective psycho­educational resources are at improving caregiver burden, caregiverstrain, depression, perceived confidence and heart failure related knowledge and help to inform the componentsof a supportive interventional study.Methods: Search terms were grouped under three concepts: caregiver, intervention study and heart failure andfive databases (PsychInfo, Medline, CINAHL Plus, EMBASE, and SCOPUS) were systematically searched toidentify studies using psycho­educational resources. Inclusion criteria determined that interventional studiespublished in English over the last ten years (2007­2017) would be included. Three reviewers independentlyscreened, extracted data and assessed the quality of included studies. Synthesis of data was undertakennarratively to identify patterns across all of the included studies and key similarities were grouped in tabularform.Results: Nine interventional studies originating from six different countries included a population of 1239participants. Outcome measures included: reduced caregiver burden, caregiver strain, depression, increasedperceived confidence and improved heart failure related knowledge. Two American studies, one Chinese studyand a study from Thailand found educational information, in the form of a booklet significantly improved heartfailure related knowledge and caregiver confidence to support patient’s self­care. Three studies found thatmultidisciplinary support sessions significantly reduced caregiver burden, depressive symptoms and increasedheart failure related knowledge. The majority of the interventions were provided immediately followingdischarge, with one American study conducted with caregivers of patients in the advanced stages of heartfailure. Synthesis of the results identified four key areas of need: education on heart failure condition andsymptoms, strategies to help with daily self­care activities, appropriate information on patient’s health status andknowing what to do in the case of an emergency.Conclusions: The findings of this systematic review highlight that psycho­educational resources can effectivelyimprove the well­being of caregivers of heart failure patients. Nurses have a key role to play in the developmentand provision of appropriate tailored education and support to both patients and their caregivers.