BACKGROUND: We sought to systematically combine the evidence on efficacy of disease management programs (DMPs) in the treatment of congestive heart failure (CHF), to identify and explain heterogeneity of results from prior studies of DMPs, and to assess potential publication bias from these studies. METHODS AND RESULTS: We conducted a systematic literature search on randomized clinical trials investigating the effect of DMPs on CHF outcomes and performed meta-analyses and meta-regressions comparing DMPs and standard care for mortality and rehospitalization. We included 36 studies from 13 different countries (with data from 8341 patients). Our meta-analysis yielded a pooled risk difference of 3% (95% confidence interval [CI] 1-6%, P < .01) for mortality and of 8% (95% CI 5-11%, P < .0001) for rehospitalization, both favoring DMP. Factors explaining heterogeneity between studies included severity of disease, proportion of beta-blocker at baseline, country, duration of follow-up, and mode of postdischarge contact. No statistically significant publication bias was detected. CONCLUSION: DMPs have the potential to reduce morbidity and mortality for patients with CHF. The benefit of the intervention depends on age, severity of disease, guideline-based treatment at baseline, and DMP modalities. Future studies should directly compare the effect of different aspects of disease management programs for different populations.
BACKGROUND: We sought to systematically combine the evidence on efficacy of disease management programs (DMPs) in the treatment of congestive heart failure (CHF), to identify and explain heterogeneity of results from prior studies of DMPs, and to assess potential publication bias from these studies. METHODS AND RESULTS: We conducted a systematic literature search on randomized clinical trials investigating the effect of DMPs on CHF outcomes and performed meta-analyses and meta-regressions comparing DMPs and standard care for mortality and rehospitalization. We included 36 studies from 13 different countries (with data from 8341 patients). Our meta-analysis yielded a pooled risk difference of 3% (95% confidence interval [CI] 1-6%, P < .01) for mortality and of 8% (95% CI 5-11%, P < .0001) for rehospitalization, both favoring DMP. Factors explaining heterogeneity between studies included severity of disease, proportion of beta-blocker at baseline, country, duration of follow-up, and mode of postdischarge contact. No statistically significant publication bias was detected. CONCLUSION:DMPs have the potential to reduce morbidity and mortality for patients with CHF. The benefit of the intervention depends on age, severity of disease, guideline-based treatment at baseline, and DMP modalities. Future studies should directly compare the effect of different aspects of disease management programs for different populations.
Authors: Hanneke W Drewes; Lotte M G Steuten; Lidwien C Lemmens; Caroline A Baan; Hendriek C Boshuizen; Arianne M J Elissen; Karin M M Lemmens; Jolanda A C Meeuwissen; Hubertus J M Vrijhoef Journal: Health Serv Res Date: 2012-03-14 Impact factor: 3.402
Authors: Debra K Moser; Victoria Dickson; Tiny Jaarsma; Christopher Lee; Anna Stromberg; Barbara Riegel Journal: Curr Cardiol Rep Date: 2012-06 Impact factor: 2.931
Authors: Owais Dar; Jillian Riley; Callum Chapman; Simon W Dubrey; Stephen Morris; Stuart D Rosen; Michael Roughton; Martin R Cowie Journal: Eur J Heart Fail Date: 2009-01-27 Impact factor: 15.534
Authors: Michele Heisler; Lakshmi Halasyamani; Mark E Cowen; Matthew D Davis; Ken Resnicow; Robert L Strawderman; Hwajung Choi; Rebecca Mase; John D Piette Journal: Circ Heart Fail Date: 2013-02-06 Impact factor: 8.790