A meta-review of evidence on heart failure disease management programs: the challenges of describing and synthesizing evidence on complex interventions.

Lori A Savard,Alexander M Clark,David R Thompson

doi:10.1186/1745-6215-12-194

Abstract

BackgroundDespite favourable results from past meta-analyses, some recent large trials have not found Heart Failure (HF) disease management programs to be beneficial. To explore reasons for this, we evaluated evidence from existing meta-analyses.MethodsSystematic review incorporating meta-review was used. We selected meta-analyses of randomized controlled trials published after 1995 in English that examined the effects of HF disease management programs on key outcomes. Databases searched: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR), DARE, NHS EED, NHS HTA, Ageline, AMED, Scopus, Web of Science and CINAHL; cited references, experts and existing reviews were also searched.Results15 meta-analyses were identified containing a mean of 18.5 randomized trials of HF interventions +/- 10.1 (range: 6 to 36). Overall quality of the meta-analyses was very mixed (Mean AMSTAR Score = 6.4 +/- 1.9; range 2-9). Reporting inadequacies were widespread around populations, intervention components, settings and characteristics, comparison, and comparator groups. Heterogeneity (statistical, clinical, and methodological) was not taken into account sufficiently when drawing conclusions from pooled analyses.ConclusionsMeta-analyses of heart failure disease management programs have promising findings but often fail to report key characteristics of populations, interventions, and comparisons. Existing reviews are of mixed quality and do not adequately take account of program complexity and heterogeneity.

Highlights

Despite favourable results from past meta-analyses, some recent large trials have not found Heart Failure (HF) disease management programs to be beneficial
Heart failure (HF) disease management programs are common in North America, Europe, and Australia [1,2]
A comprehensive search was done to identify metaanalyses of randomized controlled trials published in English that examined the effects of HF disease management programs on key outcomes

Summary

Introduction

Despite favourable results from past meta-analyses, some recent large trials have not found Heart Failure (HF) disease management programs to be beneficial. Programs have been widely introduced following recommendations from international clinical guidelines [1,3,4] but a number of recent and comparatively large trials have found no or small benefits from programs [5,6,7,8,9,10]. These inconsistencies have been explained by design issues rather than biases, reporting. Though findings from meta-analyses frequently influence guidelines, like any other research design, as the recent PRISMA guidelines acknowledge, systematic reviews can vary widely in quality [16,17]

Methods

Results

Discussion

Conclusion