Have Traditional Heart Failure Management Programs Reached Their “Use by” Date? Time to Apply More Nuanced Care

Heart failure disease management interventions: time for a reappraisal

“…This influence derived from an overwhelming focus on ‘headline’ positive effects – to the neglect of key design weaknesses, including atypically healthy populations, vaguely described interventions, and non‐described comparison group found in these and other trials and meta‐analyses . Proponents for HF disease management interventions, even currently, retrospectively gloss over the possibilities of bias created by these design flaws, continuing to label HF disease management interventions as ‘proven’ …”

“…The boundaries between science and advocacy have become blurred around HF disease management programmes. Too often those advocating disease management approaches most strongly have either ignored negative findings or dismissed these outright as resulting from biases that serve to ‘mask’ otherwise effective interventions . This advocacy, particularly when combined with overly simple research questions and simplistic methods, risks good science.…”

“…4 Proponents for HF disease management interventions, even currently, retrospectively gloss over the possibilities of bias created by these design flaws, 4,5 continuing to label HF disease management interventions as 'proven'. 6 The positive results of these early trials are curious. Indeed, the early trials 1-3 could be expected to have worse findings than subsequent trials, which could draw upon and harness insights from the previous ones.…”

“…5,14 Casting these past interventions as 'proven', proponents now call for a nuanced approach to HF management. 6 Indeed, we identified these weaknesses over a decade ago, including a plea that appeared on the cover of the Lancet including the recognition that 'Management programmes for HF have been championed on the basis of limited high-quality evidence'. 15…”