The contemporary model for managing heart failure has been extended to a patient–family caregiver dyadic context. However, the key characteristics of the model that can optimise health outcomes for both patients and caregivers remain to be investigated. This study aimed to identify the effects of dyadic care interventions on the behavioural, health, and health-service utilisation outcomes of patients with heart failure and their family caregivers and to explore how the intervention design characteristics influence these outcomes. This study involved systematic review, meta-analysis, and meta-regression techniques. We performed a systematic review and meta-analysis, using 12 databases to identify randomised controlled trials or quasi-experimental studies published in English or Chinese between database inception and 31 December 2022. The considered interventions included those targeting patients with heart failure and their family caregivers to enhance disease management. Data synthesis was performed on various patient- and caregiver-related outcomes. The identified interventions were categorised according to their design characteristics for subgroup analysis. Meta-regression was performed to explore the relationship between care delivery methods and their effectiveness. We identified 48 studies representing 9171 patient–caregiver dyads. Meta-analyses suggested the positive effects of dyadic care interventions on patients' health outcomes [Hedges' (95 % confidence interval {CI}): heart failure knowledge = 1.0 (0.26, 1.75), = 0.008; self-care confidence = 0.45 (0.08, 0.83), = 0.02; self-care maintenance = 1.12 (0.55, 1.70), < 0.001; self-care management = 1.01 (0.54, 1.49), < 0.001; anxiety = −0.18 (−0.34, −0.02), = 0.03; health-related quality of life = 0.30 (0.08, 0.51), < 0.001; hospital admission (risk ratio {95 % CI}: hospital admission = 0.79 (0.65, 0.97), = 0.007; and mortality = 0.58 (0.36, 0.93), = 0.02)]. Dyadic care interventions also improved the caregivers' outcomes [Hedges' (95 % CI): social support = 0.67 (0.01, 1.32), = 0.05; perceived burden = −1.43 (−2.27, −0.59), < 0.001]. Although the design of the identified care interventions was heterogeneous, the core care components included enabling and motivational strategies to improve self-care, measures to promote collaborative coping within the care dyads, and nurse–caregiver collaborative practice. Incorporating the first two core components appeared to enhance the behavioural and health outcomes of the patients, and the addition of the last component reduced readmission. Interventions that engaged both patients and caregivers in care provision, offered access to nurses, and optimised continuity of care led to better patient outcomes. These findings demonstrate that dyadic care interventions can effectively improve disease management in a family context, resulting in better health outcomes for both patients and caregivers. Additionally, this study provides important insights into the more-effective design characteristics of these interventions. The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42022322492).

中文翻译：

---

心力衰竭二元护理干预措施对患者和护理人员结果的影响：系统评价、荟萃分析和荟萃回归


当代治疗心力衰竭的模式已扩展到患者与家庭护理人员的二元环境。然而，该模型可以优化患者和护理人员健康结果的关键特征仍有待研究。本研究旨在确定二元护理干预措施对心力衰竭患者及其家庭护理人员的行为、健康和卫生服务利用结果的影响，并探讨干预设计特征如何影响这些结果。这项研究涉及系统评价、荟萃分析和荟萃回归技术。我们使用 12 个数据库进行了系统回顾和荟萃分析，以确定数据库建立至 2022 年 12 月 31 日期间以英文或中文发表的随机对照试验或准实验研究。考虑的干预措施包括针对心力衰竭患者及其家庭护理人员的干预措施加强疾病管理。对各种患者和护理人员相关的结果进行了数据合成。确定的干预措施根据其设计特征进行分类，以进行亚组分析。进行荟萃回归来探索护理提供方法及其有效性之间的关系。我们确定了代表 9171 名患者与护理人员二人组的 48 项研究。荟萃分析表明，二元护理干预措施对患者的健康结果具有积极影响[Hedges'（95% 置信区间 {CI}）：心力衰竭知识 = 1.0 (0.26, 1.75), = 0.008；自我保健信心 = 0.45 (0.08, 0.83), = 0.02;自我护理维护=1.12（0.55，1.70），<0.001；自我护理管理=1.01（0.54，1.49），<0.001；焦虑=−0.18（−0.34，−0.02），= 0.03；健康相关生活质量 = 0.30 (0.08, 0.51), < 0.001;入院（风险比{95% CI}：入院= 0.79（0.65，0.97），= 0.007；死亡率= 0.58（0.36，0.93），= 0.02）]。二元护理干预措施还改善了护理人员的结果 [Hedges' (95% CI)：社会支持 = 0.67 (0.01, 1.32), = 0.05；感知负担 = −1.43 (−2.27, −0.59), < 0.001]。尽管已确定的护理干预措施的设计各不相同，但核心护理组成部分包括改善自我护理的赋能和激励策略、促进护理二人组内协作应对的措施以及护士与护理人员的协作实践。纳入前两个核心成分似乎可以改善患者的行为和健康结果，而添加最后一个成分则减少了再入院率。让患者和护理人员参与护理、提供护士服务以及优化护理连续性的干预措施可以改善患者的治疗效果。这些研究结果表明，二元护理干预措施可以有效改善家庭背景下的疾病管理，从而为患者和护理人员带来更好的健康结果。此外，这项研究还为这些干预措施的更有效设计特征提供了重要见解。该审查方案已在 PROSPERO 国际系统审查前瞻性登记册中注册 (CRD42022322492)。