V. 4 N. 3 (2025): learning self-care
Articles

The Impact of Educational Interventions on Self-Care Behaviors After Cardiac Valve Replacement: A Systematic Review

PDF (English)
  • Hamilton Dollaku,
  • Camilla Elena Magi,
  • Rebecca Rollo,
  • Emanuele Buccione,
  • Marika Giuliano,
  • Nicole Ferri,
  • Renato Zipoli,
  • Valentina Fabbri,
  • Camilla Grifoni,
  • Simone Amato,
  • Ercole Vellone,
  • Paolo Iovino
Hamilton Dollaku
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Cardiopulmonary Rehabilitation, IRCCS Don Gnocchi Hospital, Florence, Italy
Camilla Elena Magi
Health Sciences Department, University of Florence, Florence, Italy
Rebecca Rollo
Department of Cardiopulmonary Rehabilitation, IRCCS Don Gnocchi Hospital, Florence, Italy
Emanuele Buccione
Department of Emergency, Health Local Authority 3, Pescara, Italy
Marika Giuliano
Department of Cardiopulmonary Rehabilitation, IRCCS Don Gnocchi Hospital, Florence, Italy
Nicole Ferri
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
Renato Zipoli
Department of Cardiopulmonary Rehabilitation, IRCCS Don Gnocchi Hospital, Florence, Italy
Valentina Fabbri
Department of Cardiopulmonary Rehabilitation, IRCCS Don Gnocchi Hospital, Florence, Italy
Camilla Grifoni
Severe Acquire Brain Injury Unit, IRCCS Don Gnocchi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy
Simone Amato
Heart Transplant Center and ECMO, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
Ercole Vellone
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland
Paolo Iovino
Health Sciences Department, University of Florence, Florence, Italy
DOI: https://doi.org/10.36253/if-3593

Pubblicato 2025-09-30

Parole chiave

  • Cardiac Valve Replacement,
  • Self-Care,
  • Educational Intervention,
  • Anticoagulation Therapy,
  • Patient Education,
  • INR Monitoring,
  • Behavior Change Techniques
    • ...Più
    Meno

Copyright (c) 2025 Hamilton Dollaku, Camilla Elena Magi, Rebecca Rollo, Emanuele Buccione, Marika Giulaino, Nicole Ferri, Renato Zipoli, Valentina Fabbri, Camilla Grifoni, Simone Amato, Ercole Vellone, Paolo Iovino

Creative Commons License

TQuesto lavoro è fornito con la licenza Creative Commons Attribuzione 4.0 Internazionale.

Abstract

Introduction. Valvular heart disease (VHD) is a growing global health issue, particularly among aging populations. Surgical valve replacement improves survival and cardiac function, yet long-term outcomes rely heavily on patient engagement in self-care. Educational interventions may enhance self-care behaviors and improve clinical and psychosocial outcomes; however, evidence remains fragmented. This systematic review aimed to evaluate the characteristics and effectiveness of educational interventions designed to support self-care in patients following cardiac valve replacement.

Methods. Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, and CINAHL from databases inception up to February 2024. Only randomized controlled trials (RCTs) assessing educational or behavioral interventions aimed at improving self-care after valve surgery were included. Outcomes were categorized as clinical (e.g., INR stability, complications), behavioral (e.g., medication adherence), or patient-reported (e.g., quality of life). Risk of bias was assessed using the ROB2 tool. Self-care behaviors targeted by interventions were classified according to to Riegel’s Middle Range Theory of Chronic Illness.

Results. Six randomized controlled trials involving 537 patients were included in the review. Interventions varied in delivery mode (all face-to-face, some with telephone or digital support), format (individual or group-based), duration, and frequency. All studies targeted self-care monitoring and management, mainly through INR self-monitoring and anticoagulation adherence, while self-care maintenance behaviors such as diet, physical activity, and psychosocial support were less frequently addressed. Interventions improved INR stability, medication adherence, self-efficacy, and psychological well-being, with some evidence for reduced complications and better quality of life. However, reporting was heterogeneous, theoretical frameworks were rarely applied, and cost-effectiveness and long-term sustainability were seldom evaluated.

Discussion and conclusion. Self-care interventions after valve replacement surgery appear effective in improving anticoagulation control and enhancing psychosocial outcomes. Yet, most programs focus narrowly on anticoagulation, overlooking lifestyle modification and broader recovery needs. Future studies should adopt standardized, theory-driven, and multidimensional approaches, integrate digital health solutions, and evaluate long-term effectiveness and cost-efficiency to ensure sustainable and equitable self-care support.

PDF (English)

Riferimenti bibliografici

  1. Santangelo G, Bursi F, Faggiano A, Moscardelli S, Simeoli PS, Guazzi M, et al. The global burden of valvular heart disease: from clinical epidemiology to management. J Clin Med. 2023;12(6):2178. https://doi.org/10.3390/jcm12062178
  2. Généreux P, Sharma RP, Cubeddu RJ, Aaron L, Abdelfattah OM, Koulogiannis KP, et al. The mortality burden of untreated aortic stenosis. J Am Coll Cardiol. 2023;82(22):2101–9. https://doi.org/10.3390/jcm12062178
  3. Raidou V, Mitete K, Kourek C, Antonopoulos M, Soulele T, Kolovou K, et al. Quality of life and functional capacity in patients after cardiac surgery intensive care unit. World J Cardiol. 2024;16(8):436. https://doi.org/10.4330/wjc.v16.i8.436
  4. Sciattella P, Scortichini M. Cost of illness of Heart Valve Diseases (HVDs): A real-world analysis in Italy. Glob Reg Health Technol Assess. 2025;12:34. https://doi.org/10.33393/grhta.2025.3243
  5. Shahim B, Shahim A, Adamo M, Chioncel O, Benson L, Crespo‐Leiro MG, et al. Prevalence, characteristics and prognostic impact of aortic valve disease in patients with heart failure and reduced, mildly reduced, and preserved ejection fraction: An analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2023;25(7):1049–60. https://doi.org/10.1002/ejhf.2908
  6. Mahesh B, Peddaayyavarla P, Ong LP, Gardiner S, Nashef SA. Cardiac surgery improves survival in advanced left ventricular dysfunction: multivariate analysis of a consecutive series of 4491 patients over an 18-year period. Eur J Cardiothorac Surg. 2016;50(5):857–66. https://doi.org/10.1093/ejcts/ezw134
  7. Seiler C. Management and follow up of prosthetic heart valves. Heart. 2004;90(7):818–24. https://doi.org/10.1136/hrt.2003.025049
  8. Alarouri HS, El Shaer A, Ponce AC, Mahayni A, Sulaiman S, Samimi S, et al. Prognostic Value of Patient‐Reported Outcomes in Predicting Long-Term Mortality After Transcatheter Aortic Valve Replacement. J Am Heart Assoc. 2023;12(19):e030383. https://doi.org/10.1161/JAHA.123.030383
  9. Brown A, Beaudry RI, Moen J, Kang S, Hassanabad AF, Vasanthan V, et al. Patient-reported outcome measures after minimally invasive mitral valve surgery: The benefit may be early. JTCVS Open. 2024;20:26–8. https://doi.org/10.1016/j.xjon.2024.05.010
  10. Berg SK, Zwisler AD, Pedersen BD, Haase K, Sibilitz KL. Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality. BMC Nurs. 2013;12:1–8. https://doi.org/10.1186/1472-6955-12-23
  11. Zandi S, Imani B, Gholamreza S. Self-care training and informational support of patients with a mechanical heart valve on the international normalized ratio and bleeding complications. Kardiochirurgia Torakochirurgia Pol J Thorac Cardiovasc Surg. 2021;18(2):80–6. https://doi.org/10.5114/kitp.2021.107468
  12. Huang Y, Li S, Lu X, Chen W, Zhang Y. The effect of self-management on patients with chronic diseases: a systematic review and meta-analysis. In MDPI; 2024. p. 2151. https://doi.org/10.3390/healthcare12212151
  13. Lee CS, Westland H, Faulkner KM, Iovino P, Thompson JH, Sexton J, et al. The effectiveness of self-care interventions in chronic illness: a meta-analysis of randomized controlled trials. Int J Nurs Stud. 2022;134:104322. https://doi.org/10.1016/j.ijnurstu.2022.104322
  14. Sahebi A, Mohammad-Aliha J, Ansari-Ramandi M, Naderi N. Investigation the relationship between self-care and readmission in patients with chronic heart failure. Res Cardiovasc Med. 2015;4(1):1–6. https://doi.org/110.5812/cardiovascmed.25472
  15. Pollack AH, Backonja U, Miller AD, Mishra SR, Khelifi M, Kendall L, et al. Closing the Gap: Supporting Patients’ Transition to Self-Management after Hospitalization. In: Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems. San Jose California USA: ACM; 2016. p. 5324–36. https://doi.org/10.1145/2858036.2858240
  16. Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. Adv Nurs Sci. 2012;35(3):194–204. https://doi.org/10.1097/ANS.0b013e318261b1ba
  17. Delimanoli E, Muurlink O, Myrianthefs P, Korompeli A. Cardiac Rehabilitation After Open Heart Surgery: A Narrative Systematic Review. J Cardiovasc Dev Dis. 2024;11(11):376. https://doi.org/10.3390/jcdd11110376
  18. Jaarsma T, Hill L, Bayes‐Genis A, La Rocca HB, Castiello T, Čelutkienė J, et al. Self‐care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021;23(1):157–74. https://doi.org/10.1002/ejhf.2008
  19. Mohsenipouya H, Majlessi F, Forooshani AR, Ghafari R. The effects of health promotion model-based educational program on self-care behaviors in patients undergoing coronary artery bypass grafting in Iran. Electron Physician. 2018;10(1):6255. https://doi.org/10.19082/6255
  20. Javan L, Kazemnejad A, Nomali M, Zakerimoghadam M. Effect of self-management program on self-efficacy and medication adherence in patients with mechanical heart valve: a randomized clinical trial. J Caring Sci. 2019;8(4):207. https://doi.org/10.15171/jcs.2019.029
  21. Salahodinkolah MK, Ganji J, Moghadam SH, Shafipour V, Jafari H, Salari S. Educational intervention for improving self-care behaviors in patients with heart failure: A narrative review. J Nurs Midwifery Sci. 2020;7(1):60–8. https://doi.org/https://doi.org/10.4103/jnms.jnms_19_19
  22. Longhini J, Gauthier K, Konradsen H, Palese A, Kabir ZN, Waldréus N. The effectiveness of nursing interventions to improve self-care for patients with heart failure at home: a systematic review and meta-analysis. BMC Nurs. 2025;24(1):286. https://doi.org/10.1186/s12912-025-02867-7
  23. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906. https://doi.org/10.1016/j.ijsu.2021.105906
  24. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:1–10. https://doi.org/10.1186/s13643-016-0384-4
  25. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366. https://doi.org/10.1136/bmj.l4898
  26. Soliman Hamad MA, Van Eekelen E, Van Agt T, Van Straten AHM. Self-management program improves anticoagulation control and quality of life: a prospective randomized study. Eur J Cardiothorac Surg. 2009 Feb;35(2):265–9. https://doi.org/10.1016/j.ejcts.2008.10.020
  27. Javan L, Kazemnejad A, Nomali M, Zakerimoghadam M. Effect of Self-Management Program on Self-efficacy and Medication Adherence in Patients with Mechanical Heart Valve: a Randomized Clinical Trial. J Caring Sci. 2019 Dec 1;8(4):207–11. https://doi.org/10.1016/10.15171/jcs.2019.029
  28. Jeon HR, Park JS. Development and Application of a Self-management Program based on Prothrombin INR Monitoring for Patients with Cardiac Valve Replacement. J Korean Acad Nurs. 2015;45(4):554. https://doi.org/10.4040/jkan.2015.45.4.554
  29. Jiang F, Lin Y, Li S, Peng Y, Huang X, Chen L. A Study of the Nursing Intervention Based on Self-Efficacy Theory for Patients After Mechanical Heart Valve Replacement: A Randomized Controlled Trial. Int J Gen Med. 2022 Aug;Volume 15:6539–47. https://doi.org/10.2147/IJGM.S353977
  30. Li D, Liu P, Zhang H, Wang L. The effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement. J Cardiothorac Surg. 2021 Dec;16(1):183. https://doi.org/10.1186/s13019-021-01437-7
  31. Sidhu P, O'Kane HO. Self-managed anticoagulation: results from a two-year prospective randomized trial with heart valve patients. Ann Thorac Surg. 2001;72(5):1523-1527. https://doi.org/10.1016/s0003-4975(01)03049-1
  32. Christensen TD, Larsen TB. Precision and accuracy of point-of-care testing coagulometers used for self-testing and self-management of oral anticoagulation therapy. J Thromb Haemost. 2012;10(2):251-260. https://doi.org/10.1111/j.1538-7836.2011.04568.x
  33. Heneghan C, Ward A, Perera R, et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet. 2012;379(9813):322-334. https://doi.org/10.1016/S0140-6736(11)61294-4
  34. Jaarsma T, Cameron J, Riegel B, Stromberg A. Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update. Curr Heart Fail Rep. 2017;14(2):71-77. https://doi.org/10.1007/s11897-017-0324-1
  35. Shimode Y, Kitai T, Iwata K, et al. Impact of stress coping style on self-care behaviors and prognosis in patients with heart failure: A prospective longitudinal observational study. Int J Cardiol. 2025;421:132865. https://doi.org/10.1016/j.ijcard.2024.132865
  36. Authors/Task Force Members:, McDonagh TA, Metra M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022;24(1):4-131. https://doi.org/10.1002/ejhf.2333
  37. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e35-e71. https://doi.org/10.1161/CIR.0000000000000932
  38. Anderson L, Oldridge N, Thompson DR, et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016;67(1):1-12. https://doi.org/10.1016/j.jacc.2015.10.044
  39. Eckstadt K. Structured Telephone Support for Heart Failure Patients: A Literature Review. Home Healthc Now. 2024;42(1):36-41. https://doi.org/10.1097/NHH.0000000000001221
  40. Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JG. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015;2015(10):CD007228. Published 2015 Oct 31. https://doi.org/10.1002/14651858.CD007228.pub3
  41. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. Published 2011 Apr 23. https://doi.org/10.1186/1748-5908-6-42
  42. Christensen TD, Johnsen SP, Hjortdal VE, Hasenkam JM. Self-management of oral anticoagulant therapy: a systematic review and meta-analysis. Int J Cardiol. 2007;118(1):54-61. https://doi.org/10.1016/j.ijcard.2006.06.018
  43. Cheng WLS, Young PMC, Luk KKH. Moderating Role of Coping Style on the Relationship between Stress and Psychological Well-Being in Hong Kong Nursing Students. Int J Environ Res Public Health. 2022;19(18):11822. Published 2022 Sep 19. https://doi.org/10.3390/ijerph191811822
  44. Vellone E, D'Agostino F, Buck HG, et al. The key role of caregiver confidence in the caregiver's contribution to self-care in adults with heart failure. Eur J Cardiovasc Nurs. 2015;14(5):372-381. https://doi.org/10.1177/1474515114547649
  45. Vellone E, Riegel B, Alvaro R. A Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-care. J Cardiovasc Nurs. 2019;34(2):166-173. https://doi.org/10.1097/JCN.0000000000000549
  46. Vellone E, Riegel B, Cocchieri A, et al. Psychometric testing of the Self-Care of Heart Failure Index Version 6.2. Res Nurs Health. 2013;36(5):500-511. https://doi.org/10.1002/nur.21554