Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta‐analysis

Abstract

Background: Disease management programmes (DMP) have been advocated to improve long term outcomes of heart failure (HF) patients. Aims: To summarise the evidence supporting DMP effectiveness in improving HF clinical outcomes. Methods: Eligible studies were located through a systematic literature search. Only randomised controlled trials (RCTs), enrolling HF patients, and allocating them to DMP or usual care (UC), were included. Information on study setting and design, participants' characteristics and interventions tested were collected. A study quality assessment was performed. Main clinical outcomes assessed were: all-cause mortality and (re)hospitalisations, HF-related (re)hospitalisations and mortality. Meta-analysis was performed according to both Yusuf -Peto method and random effects model. Results: Thirty-three RCTs were included. Mortality was significantly reduced by DMP compared to UC: OR = 0.80 (CI 0.69 -0.93, p = 0.003). All-cause and HF-related hospitalisation rates were also significantly reduced: OR = 0.76 (CI 0.69 -0.94, p < 0.00001) and OR = 0.58 (CI 0.50 -0.67, p < 0.00001), respectively. Different DMP approaches appeared to be equally effective (sensitivity analyses). Conclusion: DMP reduce mortality and hospitalisations in HF patients. Because various types of DMP appear to be similarly effective, the choice of a specific programme depends on local health services characteristics, patient population, and resources available.

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…During the past few years, a number of systematic reviews and larger randomized controlled trials (122)(123)(124)(125)(126)(127) have been performed to better estimate the effects of DMPs for HF patients on mortality and morbidity. These reviews generally found that DMPs reduce both all-cause and HF hospitalizations (122,123,(125)(126)(127). One review (124) reported a trend to reduce hospitalization rather than a significant reduction.…”

“…Pooled data from several meta-analyses (122,123,127) have demonstrated a significant reduction in mortality of 25%. Other studies have either not examined mortality (126) or examined it in a combined outcome of hospital readmission or death, showing an 18% decrease (125).…”

“…However, the published overview analyses have been able to provide some direction with regard to the most effective type of DMP. Multidisciplinary programs involving both a doctor and a nurse specializing in HF management appear to be a consistent requirement for these programs, with the potential for further benefit from the addition of other allied health professionals such as a pharmacist (122,123,126,127,138). Combinations of in-clinic and telephone follow-ups would appear to be important with entry into the DMP as soon as possible after discharge (122,124,125).…”

Treating the right patient at the right time: Access to heart failure care

“…There were three meta-analyses of randomized trials and one review assessing DMP approaches to HF care (9,(14)(15)(16). Studies included older and younger patients, patients following hospitalization, and the full spectrum of HF, including patients with severe HF.…”

Clinical trials update from the joint European Society and World Congress of Cardiology meeting: PEP‐CHF, ACCLAIM and the HHH study

“…Presented by Andrea Mortara from Monza, Italy Disease management programmes have been shown to improve outcome in heart failure patients; however, the optimal design and strategy remain to be established. (12) There is growing interest in telemonitoring as a means of helping deliver care to patients with chronic disease, including heart failure. This is driven by the increasing number of people requiring care, the increasing complexity of care, the expected decline in the number of qualified carers (since a declining proportion of the population is of working age) and the results of clinical trials.…”