title: Heart failure care management programs: a review of study interventions and meta-analysis of outcomes.
abstract: BACKGROUND
  The objective of this systematic review and meta-analysis was to describe and quantify individual interventions used in multicomponent outpatient heart failure management programs.
  
  
  METHODS
  MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials between 1995 and 2008 were searched using 10 search terms. Randomized controlled trials evaluating outpatient programs that addressed comprehensive care to decrease readmissions for patients with heart failure were identified. Forty-three articles reporting on 35 studies that reported readmissions separately from other outcomes were included. Three investigators independently abstracted primary study characteristics and outcomes.
  
  
  RESULTS
  In the 35 studies, participants included 8071 subjects who were typically older (mean [SD] age, 70.7 [6.5] years) and male (59%). Using our coding scheme, the number of individual interventions within a program ranged from 1 to 7 within individual studies; the most commonly used interventions were patient education, symptom monitoring by study staff, symptom monitoring by patients, and medication adherence strategies. Most programs had a teaching component with a mean (SD) of 6.4 (3.9) individual topics covered; frequent teaching topics were symptom recognition and management, medication review, and self-monitoring. Fewer than half of the 35 studies reviewed reported adequate data to be included in the meta-analysis. Some outcomes were infrequently reported, limiting statistical power to detect treatment effects.
  
  
  CONCLUSIONS
  A number of studies evaluating multicomponent HF management programs have found positive effects on important patient outcomes. The contribution of the individual interventions included in the multicomponent program on patient outcomes remains unclear. Future studies of chronic disease interventions must include descriptions of recommended key program components to identify critical program components.
authors.affiliation: VA Health Services Research and Development Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa, USA. wakefieldb@missouri.edu).
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Wakefield
authors.forename: Suzanne Austin
authors.initials: SA
authors.lastname: Boren
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Groves
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Conn
mesh_terms: D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008329:Managed Care Programs; D017063:Outcome Assessment, Health Care