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Published on: February 13, 2021
A systematic meta-analysis of the efficacy and heterogeneity of disease management programs in congestive heart
Alexander Göhler1, James L Januzzi, Stewart S Worrell
1Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114-4724, USA.
Insights
Disease management programs (DMPs) significantly reduce mortality and rehospitalization in patients with congestive heart failure (CHF). Program effectiveness varies based on patient factors and intervention details.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Congestive heart failure (CHF) poses a significant burden on healthcare systems.
- Disease management programs (DMPs) are increasingly implemented to improve CHF patient outcomes.
- Evidence on DMP efficacy and heterogeneity requires systematic synthesis.
Purpose of the Study:
- To systematically combine evidence on the efficacy of DMPs for CHF treatment.
- To identify and explain heterogeneity in results from prior DMP studies.
- To assess potential publication bias in DMP research.
Main Methods:
- Systematic literature search of randomized clinical trials on DMPs for CHF.
- Meta-analyses and meta-regressions comparing DMPs with standard care.
- Analysis of mortality and rehospitalization outcomes.
Main Results:
- Included 36 studies (8341 patients) from 13 countries.
- Pooled risk difference favored DMPs: 3% reduction in mortality (P < .01) and 8% in rehospitalization (P < .0001).
- Heterogeneity explained by disease severity, beta-blocker use, country, follow-up duration, and post-discharge contact.
Conclusions:
- DMPs demonstrate potential to reduce morbidity and mortality in CHF patients.
- Intervention benefit is influenced by patient age, disease severity, baseline treatment, and DMP characteristics.
- Future research should compare specific DMP components across diverse patient populations.
Background:
We sought to systematically combine the evidence on efficacy of disease management programs (DMPs) in the treatment of congestive heart failure (CHF), to identify and explain heterogeneity of results from prior studies of DMPs, and to assess potential publication bias from these studies.
Methods And Results:
We conducted a systematic literature search on randomized clinical trials investigating the effect of DMPs on CHF outcomes and performed meta-analyses and meta-regressions comparing DMPs and standard care for mortality and rehospitalization. We included 36 studies from 13 different countries (with data from 8341 patients). Our meta-analysis yielded a pooled risk difference of 3% (95% confidence interval [CI] 1-6%, P < .01) for mortality and of 8% (95% CI 5-11%, P < .0001) for rehospitalization, both favoring DMP. Factors explaining heterogeneity between studies included severity of disease, proportion of beta-blocker at baseline, country, duration of follow-up, and mode of postdischarge contact. No statistically significant publication bias was detected.
Conclusion:
DMPs have the potential to reduce morbidity and mortality for patients with CHF. The benefit of the intervention depends on age, severity of disease, guideline-based treatment at baseline, and DMP modalities. Future studies should directly compare the effect of different aspects of disease management programs for different populations.
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