What makes a disease management programme for heart failure different: Results of a meta-regression analysis

Yu, D. S. F. and Thompson, D .R. (2008). What makes a disease management programme for heart failure different: Results of a meta-regression analysis. In: International Journal of Cardiology; Abstracts of the International Symposium on Cardiovascular and Neurovascular Medicine (ISCNM) in conjunction with International Heart Failure Symposium. International Symposium on Cardiovascular and Neurovascular Medicine (ISCNM) in conjunction with International Heart Failure Symposium, Hong Kong, China, (S45-S46). 22-24 February 2008.


Author Yu, D. S. F.
Thompson, D .R.
Title of paper What makes a disease management programme for heart failure different: Results of a meta-regression analysis
Conference name International Symposium on Cardiovascular and Neurovascular Medicine (ISCNM) in conjunction with International Heart Failure Symposium
Conference location Hong Kong, China
Conference dates 22-24 February 2008
Proceedings title International Journal of Cardiology; Abstracts of the International Symposium on Cardiovascular and Neurovascular Medicine (ISCNM) in conjunction with International Heart Failure Symposium   Check publisher's open access policy
Place of Publication Ireland
Publisher Elsevier
Publication Year 2008
ISSN 0167-5273
Volume 125
Issue Supp. 1
Start page S45
End page S46
Total pages 2
Language eng
Abstract/Summary Objective of the study: Disease management programmes (DMP) have evolved to enhance discharge outcomes in patients with heart failure. Yet, randomized controlled trials (RCTs) examining their effectiveness report inconsistent findings, possibly due to variations in DMP design. We recently identified several program characteristics which may associated with a lower hospital readmission and mortality in a systematic review. We now report a meta-analysis and metaregression to identify their predictive effect on these undesirable outcomes. Methods: A search of RCTs published from 1995 to February (week 1) 2007 was preformed. Two reviewers independently assessed trials for eligibility and quality and extracted data on DMP characteristics and effects on readmission and mortality. Studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates and 95% CI were calculated with random-effect models. Subgroup analysis was conducted to compare the effects of programs of different characteristics in reducing the risk of hospital readmission and mortality. Among these program variables, meta-regression analysis, using a weighted least-square linear regression model, was conducted to identify those which significantly predicted the effect of DMP on hospital readmission and mortality. Results: 28 RCTs (N = 5667) were identified. During a pooled mean observation period of 8.5 (range, 3−18) months, DMPs significantly reduced all-cause (RR = 0.82; 95% CI 0.72−0.94; I2 22 = 75.07, p<0.001) and cardiac-cause (RR = 0.56; 95% CI 0.44−0.73; I2 10 = 26.84, p = 0.003) hospital readmissions when compared with usual care. There was also a trend towards lower all-cause mortality (RR = 0.89; 95% CI 0.78−1.01; I2 23 = 34.24, p = 0.062). Subgroup analysis indicated that the DMP team structure (multi-disciplinary team, cardiac nurseled, or with active participation of a cardiologist), care components (in-hospital care to optimize patients’ condition, drug titration, or psychosocial care), and follow-up method (home visit and telephonic approach, or multiple approach) were associated with a lower relative risk for readmission and/or mortality. Univariate metaregression indicated that multi-disciplinary and cardiac nurse-led were significantly associated with the relative risk of hospital readmission and mortality. Drug titration was also significantly associated with mortality. Multivariable meta-regression confirmed the findings and indicated that DMPs run by a multi-disciplinary team (b = −0.47, SE = 0.14, p = 0.001) or led by a cardiac nurse specialist (b = −0.38, SE = 0.13, p = 0.003) was associated with a 32−37% reduction in risk of hospital readmission whereas DMPs run by a multi-disciplinary team (b = −0.42, SE = 0.20, p = 0.001) or a cardiac nurse (b = −0.47, SE = 0.16, p = 0.005), and incorporating drug titration (b = −0.44, SE = 0.15, p = 0.003) was associated with a 55−57% reduction in mortality risk. Conclusion: Comprehensive DMPs reduce heart failure hospital readmission and mortality. The most effective DMPs for heart failure are those that involve a multi-disciplinary team or cardiac nurse and incorporate drug titration.
Subjects 321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Conference Paper
Collection: School of Medicine Publications
 
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Created: Tue, 16 Mar 2010, 12:52:46 EST by Therese Egan on behalf of School of Medicine