Home care workers in heart failure: a systematic review

Area of Science:

• Cardiology
• Gerontology
• Health Services Research

Background:

• Home care workers (HCWs), including home health aides and personal care aides, are increasingly utilized by heart failure (HF) patients for post-acute and long-term care.
• Despite their growing role, HCWs have been largely overlooked in HF research and intervention strategies.
• This systematic review addresses the gap by examining HCW utilization, impact on HF outcomes, and interventions involving HCWs.

Purpose of the Study:

• To systematically review and synthesize existing literature on the utilization of home care workers by adults with heart failure.
• To examine the effects of home care workers on heart failure patient outcomes, including readmission rates and self-care abilities.
• To review current heart failure interventions that incorporate the involvement of home care workers.

Main Methods:

• A systematic literature search was conducted across five major electronic databases (Ovid MEDLINE, EMBASE, Cochrane Library, CINAHL, AgeLine) up to August 4, 2017.
• Studies were screened using predefined inclusion/exclusion criteria, with dual review and arbitration for discrepancies.
• Data extraction and quality assessment (Downs and Black checklist) were performed, followed by a narrative synthesis due to study heterogeneity.

Main Results:

• Six studies met inclusion criteria from over 7,000 initially screened.
• Descriptive studies indicated HCW utilization by HF patients with functional/cognitive deficits living alone.
• Retrospective studies on HCWs and readmission rates yielded conflicting results; one intervention study showed improved self-care, but overall study quality was poor-to-fair.

Conclusions:

• The existing literature on home care workers in heart failure management is notably limited and of low methodological quality.
• Further research is essential to elucidate the role of HCWs in supporting HF self-care and improving patient outcomes.
• High-quality studies are warranted to address the paucity of evidence regarding HCWs' impact on heart failure patients.