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

摘要

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.