Effectiveness and Factors Determining the Success of Management Programs for Patients With Heart Failure: A Systematic Review and Meta-analysis

详细信息    查看全文

• 作者：Juana Oyanguren<sup>asup><sup> ; sup><sup>juanaoy@hotmail.com" class="auth_mail" title="E-mail the corresponding authorsup> ; Pedro Marí ; a Latorre Garcí ; a<sup>bsup> ; Jesú ; s Torcal Laguna<sup>asup> ; Iñ ; aki Lekuona Goya<sup>asup> ; Susana Rubio Martí ; n<sup>csup> ; Elena Maull Lafuente<sup>dsup> ; Gonzalo Grandes<sup>bsup>
• 关键词：Heart failure (treatment) ; Heart failure management programs (results) ; Meta-analysis ; Health care team ; Organization ; Modes of health care delivery
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：69
• 期：10
• 页码：900-914
• 全文大小：562 K

文摘

Heart failure management programs reduce hospitalizations. Some studies also show reduced mortality. The determinants of program success are unknown. The aim of the present study was to update our understanding of the reductions in mortality and readmissions produced by these programs, elucidate their components, and identify the factors determining program success.

sSec_2">Methods

spar0010">Systematic literature review (1990-2014; PubMed, EMBASE, CINAHL, Cochrane Library) and manual search of relevant journals. The studies were selected by 3 independent reviewers. Methodological quality was evaluated in a blinded manner by an external researcher (Jadad scale). These results were pooled using random effects models. Heterogeneity was evaluated with the I<sup>2sup> statistic, and its explanatory factors were determined using metaregression analysis.

sSec_3">Results

spar0015">Of the 3914 studies identified, 66 randomized controlled clinical trials were selected (18 countries, 13 535 patients). We determined the relative risks to be 0.88 for death (95% confidence interval [95%CI], 0.81-0.96; P < .002; I<sup>2sup>, 6.1%), 0.92 for all-cause readmissions (95%CI, 0.86-0.98; P < .011; I<sup>2sup>, 58.7%), and 0.80 for heart failure readmissions (95%CI, 0.71-0.90; P < .0001; I<sup>2sup>, 52.7%). Factors associated with program success were implementation after 2001, program location outside the United States, greater baseline use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, a higher number of intervention team members and components, specialized heart failure cardiologists and nurses, protocol-driven education and its assessment, self-monitoring of signs and symptoms, detection of deterioration, flexible diuretic regimen, early care-seeking among patients and prompt health care response, psychosocial intervention, professional coordination, and program duration.

sSec_4">Conclusions

spar0020">We confirm the reductions in mortality and readmissions with heart failure management programs. Their success is associated with various structural and intervention variables.