Home care workers in heart failure: a systematic review

Abstract

Background

Home care workers (HCWs), which include home health aides and personal care aides, are increasingly used by heart failure (HF) patients for post-acute care and long-term assistance. Despite their growing presence, they have largely been left out of HF research and interventions. This systematic review was aimed to 1) describe utilization patterns of HCWs by adults with HF, 2) examine the effect of HCWs on HF outcomes, and 3) review HF interventions that involve HCWs.

Methods

Five electronic databases (Ovid MEDLINE, Ovid EMBASE, Cochrane Library [Wiley], CINAHL [EBSCO], and AgeLine [EBSCO]) were searched from inception through August 4, 2017. The yield was screened using prespecified inclusion and exclusion criteria. Two authors independently reviewed references and a third reviewer acted as an arbitrator when needed. Data were extracted from articles that met the inclusion criteria. The Downs and Black checklist was used for quality assessment. Due to study heterogeneity, a narrative synthesis was conducted.

Results

Of the 7,032 studies screened, 13 underwent full-text review, and six met the inclusion criteria. Two descriptive studies found that adults with HF who live alone and have functional and cognitive deficits utilize HCWs. While three retrospective cohort studies examined the association between having an HCW post-HF hospitalization and readmission rates, their findings were conflicting. One quasi-experimental study found that an HCW-delivered educational intervention improved HF patients’ self-care abilities. Overall, despite some significant findings, the studies assessed were of poor-to-fair quality (Downs and Black score range: 10–16 [28 total points]), with most lacking methodological rigor.

Conclusion

Although HCWs are quite common, the literature on these paraprofessionals in HF is limited. Given the paucity of research in this area and the low quality of studies reviewed here, additional research is warranted on the potential role of HCWs in HF self-care and on outcomes among adults with HF.

Keywords:

• home care workers
• congestive heart failure
• home health care
• systematic review
• health services research
• quality of care
• home health aides

Supplementary materials

Supplemental material S1 Search strategy Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present Search ran on August 4, 2017

1. Home Health Aides/

2. Home Care Services/

3. House Calls/

4. (home adj3 (aide* or care or nurse* or nursing or service* or visit* or worker* or attendant* or agencies or program or programme)).mp.

5. (domestic health care or domiciliary care).mp.

6. house call*.mp.

7. or/1-6

8. exp Heart Failure/

9. (heart failure or asystole or asystolia or asystoly or Cardiac asthma or cardiac arrest or cardiac backward failure or cardiac decompensation or Cardiac Edema* or Cardiac Failure or cardiac incompetence or cardiac insufficiency or cardiac stand still or Cardio Renal Syndrome* or cardiorenal syndrome* or cardiogenic shock or cardiopulmonary insufficiency or cardiorespiratory arrest or cardiorespiratory collaps or cardiorespiratory failure or cardiovascular shock or chronic heart insufficiency or circulation arrest or circulatory arrest or decompensatio cordis or diastolic dysfunction or diastolic overload or forward failure or heart arrest or heart backward failure or heart decompensation or heart incompetence or heart insufficiency or heart left ventricle outflow tract obstruction or heart right ventricle outflow tract obstruction or heart outflow tract obstruction or heart overload or heart shock or heart standstill or heart ventricle failure or high cardiac output failure or high heart output failure or high output cardiac failure or high output failure or high output heart failure or nsufficientia cardis or insufficientia ventriculi or insufficientia ventriculi cordis or low cardiac output or low heart output or myocardial failure or myocardial insufficiency or Paroxysmal Dyspnea* or PRIS or propofol infusion syndrome* or propofol related infusion syndrome* or Renocardiac Syndrome* or Reno-Cardiac Syndrome* or Reno Cardiac Syndrome* or systolic dysfunction or systolic overload or ventricular insufficiency or ventricular overload or ventricle insufficiency or ventricle overload).mp.

10. or 9

11. and 10

Table S1 Downs and Black 27-item Checklist

Table S2 Downs and Black quality assessment of the included studies

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Acknowledgments

This study was presented at the Society of General Internal Medicine Annual Meeting in Denver, CO, on April 21, 2018.

Author contributions

MRS contributed to the development of the study protocol, oversaw data collection, extracted data from included papers, synthesized the results, drafted the manuscript, edited the tables and figures, and revised the manuscript. ALS and PBKL screened titles and abstracts, extracted data from included papers, participated in the synthesis of results, helped to draft the tables and figures of the manuscript, and revised the final draft. MMS contributed to the development of the study protocol, the drafting of the manuscript, and revised the draft. CDJ and EKT contributed to the development of the study protocol, the drafting of the manuscript, and revised the final draft. DD contributed to the development of the study protocol, conducted the analysis, oversaw data synthesis, and revised the final draft. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr Sterling was supported by the T32HS000066 from the Agency for Healthcare Research and Quality for the duration of this study. She also received the 2018 Founder’s Grant from the Society of General Internal Medicine to support her research on home care workers in heart failure. Dr Safford receives salary support for Amgen, unrelated to this work. Dr Jones was supported by K08HS024569 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The authors report no other conflicts of interest in this work.