Copyright © 2004 by the European Society of Cardiology.
Review
The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports
a Instituto de Ciencias de la Salud. Consejería de Sanidad. Junta de Comunidades de Castilla-La Mancha. Talavera de la Reina, Toledo, Spain
b Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid. Madrid, Spain
Received January 30, 2004;
revised April 2, 2004;
accepted April 8, 2004
* Corresponding author. Tel.: +34-91-497-5444; fax: +34-91-497-5353
fernando.artalejo{at}uam.es
See page 1565 for the editorial comment on this article1
Aims To systematically evaluate the published evidence regarding the effectiveness of disease management programmes (DMPs) reducing hospital re-admissions among elderly patients with heart failure (HF).
Methods and Results Computerised search of MEDLINE (1966 to 31 August 2003) and EMBASE (1966 to 31 August 2003). The Cochrane Library was also searched, and reference lists of review articles on the topic, and of all relevant studies identified, were scanned. Search and selection of studies, data-extraction using standardised forms, and assessment of study quality was performed by two reviewers. The end-point was the proportion of persons who underwent hospital re-admission, and pooled relative risks (RR) were used to summarise the effectiveness of DMPs. The meta-analysis included 54 articles, comprising 27 randomised and 27 non-randomised controlled studies. Randomised studies consistently suggested that, in comparison with usual care, DMP reduced the frequency of re-admission for HF or cardiovascular disease by 30% (pooled RR 0.70; confidence interval (CI) 95% 0.62–0.79), all-cause re-admission by 12% (pooled RR 0.88, 95% CI: 0.79–0.97), and the combined event of re-admission or death by 18% (pooled RR 0.82, 95% CI: 0.72–0.94). The results displayed no substantial variation when only DMPs with home visits, out-patient visits to a clinic, or patient follow-up longer than 6 months were included. For DMPs with out-patient clinical visits, however, the reduction in re-admission for HF or cardiovascular disease, and for all causes, did not attain statistical significance. The magnitude of DMP benefits reported by non-randomised studies was more than double that reported by randomised studies. Practically all the non-randomised studies failed to control for confounding factors, such as severity, co-morbidity and drug therapy.
Conclusion DMPs are effective at reducing re-admissions among elderly patients with HF. Their effectiveness is close to that observed in clinical trials evaluating drugs for HF, such as angiotensin-converting enzyme inhibitors, beta-blockers or digoxin. However, since none of the DMP studies compared different interventions directly, we do not know the relative effectiveness of types of healthcare delivery within the DMP.
Key Words: Heart failure • Meta-analysis • Re-admission • Elderly • Disease management programmes
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. Mendoza, M. J. Martin, A. Garcia, F. Aros, F. Aizpuru, J. Regalado De Los Cobos, M. C. Bello, P. Lopetegui, and J. M. Cia 'Hospital at home' care model as an effective alternative in the management of decompensated chronic heart failure Eur J Heart Fail, December 1, 2009; 11(12): 1208 - 1213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Bradley, W. C. Levy, and D. L. Veenstra Cost-Consequences of Ultrafiltration for Acute Heart Failure: A Decision Model Analysis Circ Cardiovasc Qual Outcomes, November 1, 2009; 2(6): 566 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Klersy, A. De Silvestri, G. Gabutti, F. Regoli, and A. Auricchio A meta-analysis of remote monitoring of heart failure patients. J. Am. Coll. Cardiol., October 27, 2009; 54(18): 1683 - 1694. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. H Bowles, D. E Holland, and D. A Horowitz A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management J Telemed Telecare, October 1, 2009; 15(7): 344 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Tibaldi, G. Isaia, C. Scarafiotti, F. Gariglio, M. Zanocchi, M. Bo, S. Bergerone, and N. A. Ricauda Hospital at Home for Elderly Patients With Acute Decompensation of Chronic Heart Failure: A Prospective Randomized Controlled Trial Arch Intern Med, September 28, 2009; 169(17): 1569 - 1575. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Clark, L. A. Savard, and D. R. Thompson What is the strength of evidence for heart failure disease-management programs? J. Am. Coll. Cardiol., July 28, 2009; 54(5): 397 - 401. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gustafsson, M. Schou, L. Videbaek, N. Dridi, H. Ryde, J. Handberg, P. R. Hildebrandt, and on behalf of the Danish Heart Failure Clinics Netw Incidence and predictors of hospitalization or death in patients managed in multidisciplinary heart failure clinics Eur J Heart Fail, April 1, 2009; 11(4): 413 - 419. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Mortara, G. D. Pinna, P. Johnson, R. Maestri, S. Capomolla, M. T. La Rovere, P. Ponikowski, L. Tavazzi, P. Sleight, and on behalf of the HHH Investigators Home telemonitoring in heart failure patients: the HHH study (Home or Hospital in Heart Failure) Eur J Heart Fail, March 1, 2009; 11(3): 312 - 318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Balk, W. Davidse, P. van Dommelen, E. Klaassen, K. Caliskan, P. van der Burgh, and C. M. Leenders Tele-guidance of chronic heart failure patients enhances knowledge about the disease. A multi-centre, randomised controlled study Eur J Heart Fail, November 1, 2008; 10(11): 1136 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Keenan, S.-L. T. Normand, Z. Lin, E. E. Drye, K. R. Bhat, J. S. Ross, J. D. Schuur, B. D. Stauffer, S. M. Bernheim, A. J. Epstein, et al. An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure Circ Cardiovasc Qual Outcomes, September 1, 2008; 1(1): 29 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Gonnah, M O Hegazi, I Hmdy, and M M M Shenoda Can a change in policy reduce emergency hospital admissions? Effect of admission avoidance team, guideline implementation and maximising the observation unit Emerg. Med. J., September 1, 2008; 25(9): 575 - 578. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Ross, G. K. Mulvey, B. Stauffer, V. Patlolla, S. M. Bernheim, P. S. Keenan, and H. M. Krumholz Statistical Models and Patient Predictors of Readmission for Heart Failure: A Systematic Review Arch Intern Med, July 14, 2008; 168(13): 1371 - 1386. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Denvir and S. J. Leslie Best practice for chronic heart failure patients--writing guidelines is not enough Eur. Heart J., July 2, 2008; 29(14): 1706 - 1708. [Full Text] [PDF]
|
|
|
|
 |
|
 I. Laniece, P. Couturier, M. Drame, G. Gavazzi, S. Lehman, D. Jolly, T. Voisin, P. O. Lang, N. Jovenin, J. B. Gauvain, et al. Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units Age Ageing, July 1, 2008; 37(4): 416 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Jaarsma and D. J. van Veldhuisen When, how and where should we "coach" patients with heart failure: The COACH results in perspective Eur J Heart Fail, April 1, 2008; 10(4): 331 - 333. [Full Text] [PDF]
|
|
|
|
|
|
T. Jaarsma, M. H. L. van der Wal, I. Lesman-Leegte, M.-L. Luttik, J. Hogenhuis, N. J. Veeger, R. Sanderman, A. W. Hoes, W. H. van Gilst, D. J. A. Lok, et al. Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) Arch Intern Med, February 11, 2008; 168(3): 316 - 324. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lainscak, J. G.F. Cleland, M. J. Lenzen, S. Nabb, I. Keber, F. Follath, M. Komajda, and K. Swedberg Recall of lifestyle advice in patients recently hospitalised with heart failure: A EuroHeart Failure Survey analysis Eur J Heart Fail, November 1, 2007; 9(11): 1095 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Clark, J. J. Yallop, L. Piterman, J. Croucher, A. Tonkin, S. Stewart, H. Krum, and CHAT Study Team Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring Eur J Heart Fail, November 1, 2007; 9(11): 1104 - 1111. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Khunti, M. Stone, S. Paul, J. Baines, L. Gisborne, A. Farooqi, X. Luan, and I. Squire Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial Heart, November 1, 2007; 93(11): 1398 - 1405. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A Clark, S. C Inglis, F. A McAlister, J. G F Cleland, and S. Stewart Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis BMJ, May 5, 2007; 334(7600): 942 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. M. Krumholz, P. M. Currie, B. Riegel, C. O. Phillips, E. D. Peterson, R. Smith, C. W. Yancy, and D. P. Faxon A Taxonomy for Disease Management: A Scientific Statement From the American Heart Association Disease Management Taxonomy Writing Group Circulation, September 26, 2006; 114(13): 1432 - 1445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. C. Huynh, A. Rovner, and M. W. Rich Long-term Survival in Elderly Patients Hospitalized for Heart Failure: 14-Year Follow-up From a Prospective Randomized Trial. Arch Intern Med, September 25, 2006; 166(17): 1892 - 1898. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. N. McLennan, S. A. Pearson, J. Cameron, and S. Stewart Prognostic importance of cognitive impairment in chronic heart failure patients: Does specialist management make a difference? Eur J Heart Fail, August 1, 2006; 8(5): 494 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S.F. Yu and D. R. Thompson An unusual meta-regression approach with a high potential of misleading conclusions: reply Eur. Heart J., May 1, 2006; 27(9): 1124 - 1125. [Full Text] [PDF]
|
|
|
|
|
|
D. S.F. Yu, D. R. Thompson, and D. T.F. Lee Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes Eur. Heart J., March 1, 2006; 27(5): 596 - 612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lainscak and I. Keber Patients' knowledge and beta blocker treatment improve prognosis of patients from a heart failure clinic Eur J Heart Fail, March 1, 2006; 8(2): 187 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Jost, B. Rauch, M. Hochadel, R. Winkler, S. Schneider, M. Jacobs, C. Kilkowski, A. Kilkowski, H. Lorenz, K. Muth, et al. Beta-blocker treatment of chronic systolic heart failure improves prognosis even in patients meeting one or more exclusion criteria of the MERIT-HF study Eur. Heart J., December 2, 2005; 26(24): 2689 - 2697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Stromberg Heart failure management programmes: The time for action has arrived Eur J Heart Fail, December 1, 2005; 7(7): 1077 - 1078. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Swedberg and I. Ekman Integrating heart failure guidelines into clinical practice Eur. Heart J. Suppl., October 1, 2005; 7(suppl_J): J21 - J25. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Pitt Review: a peridischarge multidisciplinary treatment programme reduces readmissions in heart failure Evid. Based Med., August 1, 2005; 10(4): 108 - 108. [Full Text] [PDF]
|
|
|
|
|
|
F. Rodriguez-Artalejo, P. Guallar-Castillon, C. R. Pascual, C. M. Otero, A. O. Montes, A. N. Garcia, P. Conthe, M. O. Chiva, J. R. Banegas, and M. C. Herrera Health-Related Quality of Life as a Predictor of Hospital Readmission and Death Among Patients With Heart Failure Arch Intern Med, June 13, 2005; 165(11): 1274 - 1279. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. P. Havranek Improving the Outcomes of Heart Failure Care: Putting Technology Second J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1665 - 1666. [Full Text] [PDF]
|
|
|
|
|
|
C. O. Phillips, R. M. Singa, H. R. Rubin, and T. Jaarsma Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse-led heart failure clinics. A meta-regression analysis Eur J Heart Fail, March 16, 2005; 7(3): 333 - 341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Jaarsma Health care professionals in a heart failure team Eur J Heart Fail, March 16, 2005; 7(3): 343 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Stewart Financial aspects of heart failure programs of care Eur J Heart Fail, March 16, 2005; 7(3): 423 - 428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Jaarsma and D.J. van Veldhuisen Heart failure management: how much COACH-ing is needed? Eur. Heart J., February 1, 2005; 26(3): 314 - 314. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Shelton, P. Velavan, N. P. Nikitin, A. P. Coletta, A. L. Clark, A. S. Rigby, N. Freemantle, and J. G.F. Cleland Clinical trials update from the American Heart Association meeting: ACORN-CSD, primary care trial of chronic disease management, PEACE, CREATE, SHIELD, A-HeFT, GEMINI, vitamin E meta-analysis, ESCAPE, CARP, and SCD-HeFT cost-effectiveness study Eur J Heart Fail, January 1, 2005; 7(1): 127 - 135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Rumsfeld and F. A. Masoudi Heart failure disease management works, but will it succeed? Eur. Heart J., September 2, 2004; 25(18): 1565 - 1567. [Full Text] [PDF]
|
|