The Impact of Educational Interventions on Self-Care Behaviors After Cardiac Valve Replacement: A Systematic Review

Introduction. Valvular heart disease (VHD) is a growing global health issue, particularly among aging populations. Surgical valve replacement improves survival and cardiac function, yet long-term outcomes rely heavily on patient engagement in self-care. Educational interventions may enhance self-care behaviors and improve clinical and psychosocial outcomes; however, evidence remains fragmented. This systematic review aimed to evaluate the characteristics and effectiveness of educational interventions designed to support self-care in patients following cardiac valve replacement. Methods. Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, Web of Science, and CINAHL from databases inception up to February 2024. Only randomized controlled trials (RCTs) assessing educational or behavioral interventions aimed at improving self-care after valve surgery were included. Outcomes were categorized as clinical (e.g., INR stability, complications), behavioral (e.g., medication adherence), or patient-reported (e.g., quality of life). Risk of bias was assessed using the ROB2 tool. Self-care behaviors targeted by interventions were classified according to to Riegel’s Middle Range Theory of Chronic Illness. Results. Six randomized controlled trials involving 537 patients were included in the review. Interventions varied in delivery mode (all face-to-face, some with telephone or digital support), format (individual or group-based), duration, and frequency. All studies targeted self-care monitoring and management, mainly through INR self-monitoring and anticoagulation adherence, while self-care maintenance behaviors such as diet, physical activity, and psychosocial support were less frequently addressed. Interventions improved INR stability, medication adherence, self-efficacy, and psychological well-being, with some evidence for reduced complications and better quality of life. However, reporting was heterogeneous, theoretical frameworks were rarely applied, and cost-effectiveness and long-term sustainability were seldom evaluated. Discussion and conclusion. Self-care interventions after valve replacement surgery appear effective in improving anticoagulation control and enhancing psychosocial outcomes. Yet, most programs focus narrowly on anticoagulation, overlooking lifestyle modification and broader recovery needs. Future studies should adopt standardized, theory-driven, and multidimensional approaches, integrate digital health solutions, and evaluate long-term effectiveness and cost-efficiency to ensure sustainable and equitable self-care support.