A meta-review of evidence on heart failure disease management programs: the challenges of describing and synthesizing evidence on complex interventions

Abstract

BackgroundDespite favourable results from past meta-analyses, some recent large trials have not found Heart Failure (HF) disease management programs to be beneficial. To explore reasons for this, we evaluated evidence from existing meta-analyses.MethodsSystematic review incorporating meta-review was used. We selected meta-analyses of randomized controlled trials published after 1995 in English that examined the effects of HF disease management programs on key outcomes. Databases searched: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR), DARE, NHS EED, NHS HTA, Ageline, AMED, Scopus, Web of Science and CINAHL; cited references, experts and existing reviews were also searched.Results15 meta-analyses were identified containing a mean of 18.5 randomized trials of HF interventions +/- 10.1 (range: 6 to 36). Overall quality of the meta-analyses was very mixed (Mean AMSTAR Score = 6.4 +/- 1.9; range 2-9). Reporting inadequacies were widespread around populations, intervention components, settings and characteristics, comparison, and comparator groups. Heterogeneity (statistical, clinical, and methodological) was not taken into account sufficiently when drawing conclusions from pooled analyses.ConclusionsMeta-analyses of heart failure disease management programs have promising findings but often fail to report key characteristics of populations, interventions, and comparisons. Existing reviews are of mixed quality and do not adequately take account of program complexity and heterogeneity.

Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends

“…7 Since the seminal trials of heart failure disease management in the 1990s, 8,9 several meta-analyses have demonstrated the benefits of multidisciplinary approaches in decreasing hospitalizations, improving quality of life, and decreasing mortality. [10][11][12] A metareview of 15 meta-analyses over the past decade found that although most analyses showed a clear benefit, it was difficult to calculate the point estimate of the benefit because of the heterogeneity of the results between trials. 12 In addition, other systematic reviews examined program components, such as transitional care 13 and telehealth.…”

Influence of Psychoemotional Disorders on the Effectiveness of Education and Active Outpatient Control in Heart Failure Patients

“…Depressed patients reacted a little worse on the program, but there were no any statistical significance for the risk of primary endpoints. Программы управления болезнью (ПУБ)/(DMP), представляющие собой обучение пациентов и активный амбулаторный контроль, получили широкое распростра-нение в общей структуре медицинской помощи пациен-там с сердечной недостаточностью (СН) в развитых стра-нах и рекомендованы ведущими профессиональными сообществами [1][2][3][4]. Однако исследования показывают, что эффективность таких программ может широко варь-ировать в зависимости от их структуры и содержания, а также в зависимости от базовых характеристик вклю-ченных пациентов.…”

Usefulness of Wearable Cameras as a Tool to Enhance Chronic Disease Self-Management: Scoping Review (Preprint)

“…Improved self-management has been associated with reduced mortality, hospital admissions, and healthcare costs [5,6]. For example, a trial of nurse-led education to improve selfmanagement in heart failure demonstrated significant reductions in cardiac (20%) and heart failure-related (17%) [6] hospitalisations.…”