Effectiveness and Factors Determining the Success of Management Programs for Patients With Heart Failure: A Systematic Review and Meta-analysis.
OBJECTIVE
Heart failure management programs reduce hospitalizations. Some studies also show reduced mortality. The determinants of program success are unknown. The aim of the present study was to update our understanding of the reductions in mortality and readmissions produced by these programs, elucidate their components, and identify the factors determining program success.


METHODS
Systematic literature review (1990-2014; PubMed, EMBASE, CINAHL, Cochrane Library) and manual search of relevant journals. The studies were selected by 3 independent reviewers. Methodological quality was evaluated in a blinded manner by an external researcher (Jadad scale). These results were pooled using random effects models. Heterogeneity was evaluated with the I2statistic, and its explanatory factors were determined using metaregression analysis.


RESULTS
Of the 3914 studies identified, 66 randomized controlled clinical trials were selected (18 countries, 13 535 patients). We determined the relative risks to be 0.88 for death (95% confidence interval [95%CI], 0.81-0.96; P < .002; I2, 6.1%), 0.92 for all-cause readmissions (95%CI, 0.86-0.98; P < .011; I2, 58.7%), and 0.80 for heart failure readmissions (95%CI, 0.71-0.90; P < .0001; I2, 52.7%). Factors associated with program success were implementation after 2001, program location outside the United States, greater baseline use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, a higher number of intervention team members and components, specialized heart failure cardiologists and nurses, protocol-driven education and its assessment, self-monitoring of signs and symptoms, detection of deterioration, flexible diuretic regimen, early care-seeking among patients and prompt health care response, psychosocial intervention, professional coordination, and program duration.


CONCLUSIONS
We confirm the reductions in mortality and readmissions with heart failure management programs. Their success is associated with various structural and intervention variables.
Departamento de Cardiología y Atención Primaria, Organización Sanitaria Integrada Hospital de Galdakao-Comarca Interior, Osakidetza-Servicio Vasco de Salud, Galdácano, Vizcaya, Spain. Electronic address: juanaoy@hotmail.com.
Juana
J
Oyanguren
Unidad de Investigación de Atención Primaria, Osakidetza-Servicio Vasco de Salud, Vizcaya, Spain.
Pedro María
PM
Latorre García
Departamento de Cardiología y Atención Primaria, Organización Sanitaria Integrada Hospital de Galdakao-Comarca Interior, Osakidetza-Servicio Vasco de Salud, Galdácano, Vizcaya, Spain.
Jesús
J
Torcal Laguna
Departamento de Cardiología y Atención Primaria, Organización Sanitaria Integrada Hospital de Galdakao-Comarca Interior, Osakidetza-Servicio Vasco de Salud, Galdácano, Vizcaya, Spain.
Iñaki
I
Lekuona Goya
Departamento de Cardiología, Hospital Virgen de la Salud de Toledo, SESCAM-Servicio de Salud de Castilla-La Mancha, Toledo, Spain.
Susana
S
Rubio Martín
Departamento de Cardiología, Hospital Parc Salut del Mar, Barcelona, Spain.
Elena
E
Maull Lafuente
Unidad de Investigación de Atención Primaria, Osakidetza-Servicio Vasco de Salud, Vizcaya, Spain.
Gonzalo
G
Grandes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
D002316:Cardiotonic Agents
Equipo de trabajo; Health care team; Heart failure (treatment); Heart failure management programs (results); Insuficiencia cardiaca (tratamiento); Meta-analysis; Metanálisis; Modes of health care delivery; Método de provisión de cuidados; Organización; Organization; Programas de atención a la insuficiencia cardiaca (resultados)