Conclusions and Future Directions
Self-management is considered a cornerstone of CHF outcomes; however, poor patient adherence is common. Patients and their partners may be empowered to self-care through a supportive relationship with their healthcare professional, but can be limited by the complex demands of maintaining their regimen. Strategies designed to optimise patient self-management have shown some success in improving symptom monitoring, but these have not translated to reduced hospital admissions or mortality risk. There is high-level evidence to support patient medication adherence, exercise training and smoking cessation to reduce hospital admissions and mortality risk.3 Conversely, evidence to support a morbidity and survival benefit of other patient self-care behaviours (such as symptom monitoring, restricted fluid, sodium and diet, and optimised mental health) is less conclusive. The Patient Care Committee of the Heart Failure Association of the European Society of Cardiology2 provides a good summary of the evidence – and evidence gaps – supporting patient self-management. Future research that systematically evaluates programme components to identify drivers of positive outcomes is needed to develop this evidence base.
New work in this field that adopts e-health technologies, such as the PROMETHEUS,37 BEAT-HF38 and CHF-CePPORT39 trials, will undoubtedly inform future practice. Recent developments point to a role for social networks in self-management support,42 although efficacy is not yet well-established. Vassilev et al43 suggest that social networks may effect change in self-management by improving awareness and access to network resources, adjusting social roles, relationships and communication in response to needs and through collective efficacy to achieve behavioural goals. Future research that harnesses a social network perspective to enlist and mobilise collective resources through e-health interventions may improve self-management in chronic disease settings.