Effect of personalized nursing on readmission and quality of life in heart failure patients a systematic review and meta-analysis

Heart failure (HF) imposes a severe global clinical and economic burden, with unplanned hospital readmission and impaired health-related quality of life (HRQoL) as two dominant adverse patient outcomes. Conventional standardized nursing fails to accommodate heterogeneous individual clinical and psychosocial demands, while personalized nursing delivers patient-tailored care aligned with each patient’s cardiac status and self-management capacity. Current randomized controlled trial (RCT) evidence regarding its combined effects on readmission and HRQoL remains inconsistent. This systematic review and meta-analysis quantified pooled effects of personalized nursing on hospital readmission and HRQoL among adult HF patients. Secondary objectives included identifying inter-study heterogeneity via subgroup and sensitivity analyses, and grading overall evidence certainty using the GRADE framework. Comprehensive electronic searches were performed across PubMed, Embase, Web of Science and the Cochrane Library from database inception to 30 April 2025. An updated supplementary search conducted on 15 June 2026 (covering May 2025–June 2026) retrieved no additional eligible RCTs. The review protocol was prospectively registered on 15 March 2025 via PROSPERO (Registration No.: CRD42025567890). Eligible parallel-group RCTs compared standardized personalized nursing against routine HF care. Personalized nursing was operationalized as nurse-led patient-centred programmes containing a minimum of four core modules, with interventions required to incorporate at least two components: (1) literacy-adjusted individualized health education; (2) risk-stratified adaptive follow-up via telephone, home visits or telemonitoring; (3) structured behavioural coaching for medication adherence and lifestyle modification; (4) multidisciplinary care coordination. Programmes relying solely on generic printed materials or delivered by non-nursing staff were excluded. Random-effects models were adopted to pool risk ratios (RR) for readmission and standardized mean differences (SMD) for HRQoL. All HRQoL scale scores were directionally harmonized to enable uniform interpretation of effect sizes. Heterogeneity, sensitivity testing and publication bias assessments followed PRISMA 2020 and Cochrane Handbook standards. Full database-specific search syntax is provided in Supplementary Material 1. Fourteen RCTs enrolling a total of 2,356 HF participants were included for quantitative synthesis. Relative to standard care, personalized nursing significantly reduced readmission risk (RR = 0.68, 95%CI 0.55–0.84, p < 0.001; I²=48%, τ²=0.03, 95% prediction interval 0.42–1.09) and yielded moderate-to-large HRQoL improvements (SMD = − 0.72, 95%CI − 0.94 to − 0.49, p < 0.001; I²=57%). Moderate inter-study heterogeneity was detected for both endpoints. Subgroup analyses confirmed comparable benefits for tele-nursing and face-to-face delivery; stronger therapeutic effects were observed in multicomponent interventions and trials with follow-up exceeding six months. No statistically significant publication bias was identified via funnel plot inspection, Egger’s and Begg’s tests. Moderate-certainty pooled evidence demonstrates that standardized personalized nursing reduces unplanned hospital readmission and improves patient-reported HRQoL in adults with heart failure. Integrating multicomponent tailored nursing into routine HF management may alleviate healthcare utilization burdens and support sustained long-term disease control.