Self-management strategies in people with heart failure-related fatigue: a systematic review

Introduction: Fatigue is a common symptom of heart failure which can be distressing for patients and negatively impact both their quality of life and prognosis. We report the efficacy of self-management strategies for people with heart failure-related fatigue. Methods and results: We searched the MEDLINE, Psychinfo, Emcare and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to August 2021 for relevant trials. Twenty-two papers were included describing 21 trials (15 RCTs), comprising 515 participants.   Definitions of interventions are given and were grouped as either supported self-management or self-management interventions. Supported self-management included education and person-centred care interventions (n=5). Self-management interventions included mind-body therapies (10), and diet and supplements (6).  The Cochrane risk of bias did not show significant high risk across the domains, however the number of participants recruited was small. There was heterogeneity in intervention type, delivery and outcome measures preventing meta-analysis. Evidence for supported self-management interventions involving education and a person-centred approach, and self-management interventions such as CBT, mindfulness, and some supplements for heart failure-related fatigue is positive, but is limited to individual, small trials. Only eight trials provided a definition of fatigue, and 11 types of fatigue outcome measures were used. Conclusion: The evidence base for the efficacy of supported self-management and self-management interventions for alleviating heart failure-related fatigue is modest in both study number, size, and quality. Further well-designed trials are needed, along with consensus work on fatigue definitions and reporting.