| A systematic meta-analysis of the efficacy and heterogeneity of disease management programs in congestive heart failure. | |
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MedLine Citation:
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PMID: 16952790 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Alexander Göhler; James L Januzzi; Stewart S Worrell; Karl Josef Osterziel; G Scott Gazelle; Rainer Dietz; Uwe Siebert |
Publication Detail:
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Type: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Journal of cardiac failure Volume: 12 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2006 Sep |
Date Detail:
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Created Date: 2006-09-05 Completed Date: 2006-10-17 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 554-67 Citation Subset: IM |
Affiliation:
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Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114-4724, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Clinical Protocols* Guideline Adherence Heart Failure / mortality, physiopathology, therapy* Hospitalization Humans Patient Readmission Practice Guidelines as Topic Severity of Illness Index Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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