Metaanalysis and review of heart failure disease management randomized controlled clinical trials.
BACKGROUND
The medical community has turned to disease management (DM) to bridge the gap between proven therapies and clinical practice for patients with heart failure (HF). The aim of this study was to assess the effectiveness of DM programs in reducing hospitalization and mortality in patients with HF on the basis of the results of existing trials.


METHODS
We compared the published results from 19 randomized controlled clinical trials evaluating HF DM programs. A random effects model was used to combine the hazards ratio for all-cause hospitalization across the studies evaluating specific types of HF DM programs.


RESULTS
We identified 19 relevant studies, with 5752 enrolled patients, which assessed the benefits of HF DM programs. The overall effect was a significant decrease in all-cause hospitalization for patients with HF. There was significant heterogeneity in the results (P < .0001).


CONCLUSIONS
The results of this analysis indicate that HF DM is an intervention that could significantly decrease hospitalization for patients with HF. However, due to differences in the types of strategies and the variety of health care settings in which they were evaluated, further studies of HF DM programs with multiple participating centers are required.
Department of Medicine, Jefferson Medical College, Philadelphia, Pa 19107, USA. david.whellan@jefferson.edu
David J
DJ
Whellan
Vic
V
Hasselblad
Eric
E
Peterson
Christopher M
CM
O'Connor
Kevin A
KA
Schulman
D000368:Aged; D001315:Australia; D002317:Cardiovascular Agents / Q000627:therapeutic use; D019090:Case Management / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D002985:Clinical Protocols; D004363:Drug Utilization / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics / Q000451:nursing / Q000628:therapy*; D006699:Home Care Services; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D008962:Models, Theoretical; D009656:North America; D010044:Outpatient Clinics, Hospital; D010347:Patient Care Planning; D010348:Patient Care Team; D016016:Proportional Hazards Models; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012306:Risk
D002317:Cardiovascular Agents