What is the strength of evidence for heart failure disease-management programs?

Clark, Alexander M., Savard, Lori A. and Thompson, David R. (2009) What is the strength of evidence for heart failure disease-management programs?. Journal of the American College of Cardiology, 54 5: 397-401. doi:10.1016/j.jacc.2009.04.051

Author Clark, Alexander M.
Savard, Lori A.
Thompson, David R.
Title What is the strength of evidence for heart failure disease-management programs?
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
Publication date 2009-07
Year available 2009
Sub-type Article (original research)
DOI 10.1016/j.jacc.2009.04.051
Volume 54
Issue 5
Start page 397
End page 401
Total pages 5
Editor Anthony N DeMaria
Place of publication United States
Publisher American College of Cardiology
Collection year 2010
Language eng
Subject C1
920210 Nursing
920103 Cardiovascular System and Diseases
110201 Cardiology (incl. Cardiovascular Diseases)
111099 Nursing not elsewhere classified
Abstract Heart failure (HF) disease-management programs are increasingly common. However, some large and recent trials of programs have not reported positive findings. There have also been parallel recent advances in reporting standards and theory around complex nonpharmacological interventions. These developments compel reconsideration in this Viewpoint of how research into HF-management programs should be evaluated, the quality, specificity, and usefulness of this evidence, and the recommendations for future research. Addressing the main determinants of intervention effectiveness by using the PICO (Patient, Intervention, Comparison, and Outcome) approach and the recent CONSORT (Consolidated Standards of Reporting Trials) statement on nonpharmacological trials, we will argue that in both current trials and meta-analyses, interventions and comparisons are not sufficiently well described; that complex programs have been excessively oversimplified; and that potentially salient differences in programs, populations, and settings are not incorporated into analyses. In preference to more general meta-analyses of programs, adequate descriptions are first needed of populations, interventions, comparisons, and outcomes in past and future trials. This could be achieved via a systematic survey of study authors based on the CONSORT statement. These more detailed data on studies should be incorporated into future meta-analyses of comparable trials and used with other techniques such as patient-based outcomes data and meta-regression. Although trials and meta-analyses continue to have potential to generate useful evidence, a more specific evidence base is needed to support the development of effective programs for different populations and settings.
Keyword Chronic
Health promotion
Self care
Disease management
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