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Clinical service organisation for heart failure
S Taylor1, J Bestall, S Cotter
1Centre for General Practice and Primary Care, St Bartholomew's and The Royal London School of Medicine and Dentistry, Mile End Road, London, UK, E1 4NS. s.j.c.taylor@qmul.ac.uk
The Cochrane Database of Systematic Reviews
|April 23, 2005
Summary
Disease management interventions for chronic heart failure (CHF) show potential, particularly case management, which may reduce mortality in high-quality studies. Further research is needed to confirm effectiveness and explore patient outcomes.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Chronic heart failure (CHF) is a prevalent condition leading to frequent hospitalizations.
- Various clinical service organization interventions aim to manage CHF patients.
Purpose of the Study:
- To evaluate the effectiveness of disease management interventions for patients with CHF.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing CHF disease management interventions to usual care.
- Searched multiple databases (Cochrane CENTRAL, MEDLINE, EMBASE, etc.) up to July 2003.
- Data extraction and quality assessment performed independently by at least two reviewers.
Main Results:
- Sixteen trials involving 1,627 patients were included, categorized into multidisciplinary, case management, and clinic interventions.
- Case management interventions showed a trend towards reduced all-cause mortality, significant in higher-quality studies (OR 0.68, 95% CI 0.46-0.98).
- Weak evidence suggested case management may reduce heart failure admissions; multidisciplinary interventions showed short-term reduction in heart failure re-admissions. Clinic interventions lacked strong supporting evidence.
Conclusions:
- Current data are insufficient to make definitive recommendations for CHF disease management interventions.
- Further adequately powered, multi-center studies are required.
- Future research should assess intervention impact on quality of life, patient/carer satisfaction, and cost-effectiveness.