Impact of telehealth on patient self-management of heart failure: a review of literature.

PURPOSE: The objective of the study was to explore the impact of telehealth interventions on individuals' self-care of heart failure (HF).

BACKGROUND: Heart failure is a chronic illness that requires a complex treatment regimen over a long period. Historically, effective self-care has been difficult for this population. There is a need for innovative and effective approaches to improve individual self-care. Telehealth can potentially help individuals with HF follow the plan of care resulting in improved health outcomes and a better quality of life.

REVIEW METHODS: A comprehensive computer-assisted literature search using the terms "(telemedicine OR telehealth) AND (self-care OR self-management) AND (heart failure)" was conducted using electronic databases of ASP, CINAHL, Cochrane reviews, ERIC, PubMed, PsychINFO, Social Sciences Abstracts Index, and Web of Science for studies published between 2000 and 2010 to find research that met the inclusion criteria.

RESULTS: Fourteen studies were included in the review. Telehealth resulted in significant improvement of HF self-care behaviors of daily weighing, medication management, exercise adherence, fluid and alcohol restriction, salt restriction, or stress reduction in the telehealth intervention group in 5 studies. Participants reported improved HF self-care behaviors in 3 other studies with pretest-posttest design. Five others found no difference between the intervention and control groups. Content analysis of the data in the qualitative study revealed themes suggesting that telehealth can be effective in promoting self-care for individuals with HF. However, small sample size and inadequate measurement methods limit the generalizability of the findings of the studies included in this review.

CONCLUSION: Although this review included several studies with flawed design issues, the available evidence supports the use of telehealth in enabling self-care of HF. Further exploration is needed to determine the effect of telehealth on HF self-care outcomes using studies with high-quality design and improved data collection procedures.