Nurse-Led, Technology-Based Interventions to Improve Self-Care in Heart Failure Patients After Hospital Discharge: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

AIMS: To assess the evidence supporting the implementation of nurse-led, technology-based interventions to improve the self-care of patients discharged from hospital with heart failure (HF) and at high risk of poor health outcomes. METHODS: We followed PRISMA guidelines, searching PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, CINAHL, Clinical Key, Cochrane CENTRAL, ClinicalTrials.gov, and Google Scholar for randomized controlled trials (RCTs) comparing post-discharge, nurse-led, technology-based self-care programs (e.g., telehealth education, mobile apps) versus usual care applied to adult HF patients. The main outcome measure was the Self-Care of Heart Failure Index (SCHFI). Data was pooled in RevMan 5.4.1 using random effects. RESULTS: Overall, 9 RCTs comprising 952 participants with a mean age ∼59-78 years, 65% male and most NHYA Class II-III were included. Seven trials applied telephone-based support, one a mobile-health (mHealth) app, and the other an avatar-based app. Intervention content included structured education, motivational interviewing, and symptom monitoring. Technology-based, nurse-delivered interventions showed statistically significant positive effects on self-maintenance (SMD = 0.97; 95% CI: 0.57-1.37), self-management (SMD = 0.84; 95% CI: 0.40-1.28), and self-confidence (SMD = 0.80; 95% CI: 0.47-1.13) with m-health and telephone-based approaches demonstrating the most significant effects. However, heterogeneity was consistently high across all outcomes (I2 = 82%-90%), which may be explained by variations in follow-up. CONCLUSION: Nurse-led, technology-based interventions significantly enhanced self-care maintenance, management, and confidence in post-discharge HF patients, whilst demonstrating other benefits. However, high between-study variability, reflecting diverse care settings, cultures, and technologies, also limits their generalizability. REGISTRATION: PROSPERO CRD42025633134.