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Review
. 2017 Jul/Aug;32(4):372-382.
doi: 10.1097/JCN.0000000000000350.

Caregiver Well-being and Patient Outcomes in Heart Failure: A Meta-analysis

Julie T Bidwell  1 , Karen S Lyons, Christopher S Lee
Affiliations
Review

Caregiver Well-being and Patient Outcomes in Heart Failure: A Meta-analysis

Julie T Bidwell et al. J Cardiovasc Nurs. 2017 Jul/Aug.

Abstract

Background: Despite evidence from the broader caregiving literature about the interdependent nature of the caregiving dyad, few studies in heart failure (HF) have examined associations between caregiver and patient characteristics.

Objective: The aim of this study is to quantitatively synthesize the relationships between caregiver well-being and patient outcomes.

Methods: The MEDLINE, PsycINFO, and CINAHL databases were searched for studies of adult HF patients and informal caregivers that tested the relationship between caregiver well-being (perceived strain and psychological distress) and patient outcomes of interest. Summary effects across studies were estimated using random effects meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: A total of 15 articles meeting inclusion criteria were included in the meta-analysis. Taking into account differences across studies, higher caregiver strain was associated significantly with greater patient symptoms (Fisher z = 0.22, P < .001) and higher caregiver strain was associated significantly with lower patient quality of life (Fisher z = -0.36, P < .001). Relationships between caregiver psychological distress and both patient symptoms and quality of life were not significant. Although individual studies largely found significant relationships between worse caregiver well-being and higher patient clinical event-risk, these studies were not amenable to meta-analysis because of substantial variation in event-risk measures.

Conclusions: Clinical management and research approaches that acknowledge the interdependent nature of the caregiving dyad hold great potential to benefit both patients and caregivers.

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Conflict of interest statement

Conflicts of Interest

None declared.

Figures

Figure 1
Figure 1
Figure 2
Figure 2
Random effects meta-analysis of relationship between caregiver strain and patient symptoms of HF. Note: Fisher’s z converted to metric of Pearson’s r = 0.213. Egger’s test for bias of small study effects: t = 1.60, p = 0.170.
Figure 3
Figure 3
Random effects meta-analysis of relationship between caregiver psychological distress and patient symptoms of HF. Note: Fisher’s Z converts to the metric of Pearson’s r as follows: for HSC summary effect r = 0.136; for BDI summary effect r = −0.105; for CES-D summary effect r = 0.226; for Other Depression summary effect r = 0.073; for Overall summary effect r = 0.060. Egger’s test for bias of small study effects: t = −0.71, p =0.502.
Figure 4
Figure 4
Random-effects meta-analysis of relationship between caregiver psychological distress and patient QOL. Note: Fisher’s Z when converted to metric of Pearson’s r = −0.079. Egger’s test for bias of small study effects: t = 0.15, p = 0.898.
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