1. Effectiveness and Factors Determining the Success of Management Programs for Patients With Heart Failure: A Systematic Review and Meta-analysis
- Author
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Iñaki Lekuona Goya, Gonzalo Grandes, Elena Maull Lafuente, Juana Oyanguren, Jesús Torcal Laguna, Pedro María Latorre García, and Susana Rubio Martín
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cardiotonic Agents ,030204 cardiovascular system & hematology ,Cochrane Library ,Patient Readmission ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Multicenter Studies as Topic ,Medicine ,030212 general & internal medicine ,Intensive care medicine ,Aged ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,Heart Failure ,Patient Care Team ,business.industry ,Disease Management ,Stroke Volume ,General Medicine ,Middle Aged ,Jadad scale ,Hospitalization ,Clinical trial ,Treatment Outcome ,Systematic review ,Relative risk ,Meta-analysis ,Quality of Life ,Female ,business ,Psychosocial - Abstract
Introduction and objectives 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 I 2 statistic, 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 2 , 6.1%), 0.92 for all-cause readmissions (95%CI, 0.86-0.98; P 2 , 58.7%), and 0.80 for heart failure readmissions (95%CI, 0.71-0.90; P 2 , 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.
- Published
- 2016