A systematic meta-analysis of the efficacy and heterogeneity of disease management programs in congestive heart failure.
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.


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.


CONCLUSIONS
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.
Göhler
Alexander
A
Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114-4724, USA.
Januzzi
James L
JL
Worrell
Stewart S
SS
Osterziel
Karl Josef
KJ
Gazelle
G Scott
GS
Dietz
Rainer
R
Siebert
Uwe
U
D000367:Age Factors; D002985:Clinical Protocols; D019983:Guideline Adherence; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome