What Is the Strength of Evidence for Heart Failure Disease-Management Programs?

Alexander M. Clark, Lori A. Savard, David R. Thompson

    Research output: Contribution to journalReview articlepeer-review

    72 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)397-401
    Number of pages5
    JournalJournal of the American College of Cardiology
    Volume54
    Issue number5
    DOIs
    Publication statusPublished - 28 Jul. 2009

    Keywords

    • CHF
    • chronic
    • disease management
    • health promotion
    • self care

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