A systematic review of the main mechanisms of heart failure disease management interventions.

OBJECTIVE: To identify the main mechanisms of heart failure (HF) disease management programmes based in hospitals, homes or the community. METHODS: Systematic review of qualitative and quantitative studies using realist synthesis. The search strategy incorporated general and specific terms relevant to the research question: HF, self-care and programmes/interventions for HF patients. To be included, papers had to be published in English after 1995 (due to changes in HF care over recent years) to May 2014 and contain specific data related to mechanisms of effect of HF programmes. 10 databases were searched; grey literature was located via Proquest Dissertations and Theses, Google and publications from organisations focused on HF or self-care. RESULTS: 33 studies (n=3355 participants, mean age: 65 years, 35% women) were identified (18 randomised controlled trials, three mixed methods studies, six pre-test post-test studies and six qualitative studies). The main mechanisms identified in the studies were associated with increased patient understanding of HF and its links to self-care, greater involvement of other people in this self-care, increased psychosocial well-being and support from health professionals to use technology. CONCLUSION: Future HF disease management programmes should seek to harness the main mechanisms through which programmes actually work to improve HF self-care and outcomes, rather than simply replicating components from other programmes. The most promising mechanisms to harness are associated with increased patient understanding and self-efficacy, involvement of other caregivers and health professionals and improving psychosocial well-being and technology use.

Preparing today's cardiovascular trainees to meet the challenges of tomorrow: team research and interdisciplinary training.

There is a growing focus on interdisciplinary team approaches in science and public health research, including cardiology. This trend is apparent in a large body of team publications and the strong interest from the funding agencies to support interdisciplinary research. Despite this increased emphasis on the importance and roles of teams, schools fail to better prepare their students and trainees with skills that allow them to work in or lead teams. In this article, we discuss the strengths and weaknesses of different team models and highlight the training program implemented by the Alberta Heart Failure Etiology and Analysis Research Team (HEART), which involves 24 scientists/mentors across the research and health care spectrum focused on understanding heart failure with preserved ejection fraction.