Roccaforte Rosa, Demers Catherine, Baldassarre Fulvia, Teo Koon K, Yusuf Salim
Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Ontario, Canada.
Eur J Heart Fail. 2005 Dec;7(7):1133-44. doi: 10.1016/j.ejheart.2005.08.005. Epub 2005 Sep 29.
Disease management programmes (DMP) have been advocated to improve long term outcomes of heart failure (HF) patients.
To summarise the evidence supporting DMP effectiveness in improving HF clinical outcomes.
Eligible studies were located through a systematic literature search. Only randomised controlled trials (RCTs), enrolling HF patients, and allocating them to DMP or usual care (UC), were included. Information on study setting and design, participants' characteristics and interventions tested were collected. A study quality assessment was performed. Main clinical outcomes assessed were: all-cause mortality and (re)hospitalisations, HF-related (re)hospitalisations and mortality. Meta-analysis was performed according to both Yusuf-Peto method and random effects model.
Thirty-three RCTs were included. Mortality was significantly reduced by DMP compared to UC: OR = 0.80 (CI 0.69-0.93, p = 0.003). All-cause and HF-related hospitalisation rates were also significantly reduced: OR = 0.76 (CI 0.69-0.94, p < 0.00001) and OR = 0.58 (CI 0.50-0.67, p < 0.00001), respectively. Different DMP approaches appeared to be equally effective (sensitivity analyses).
DMP reduce mortality and hospitalisations in HF patients. Because various types of DMP appear to be similarly effective, the choice of a specific programme depends on local health services characteristics, patient population, and resources available.
疾病管理项目（DMP）已被提倡用于改善心力衰竭（HF）患者的长期预后。
总结支持DMP在改善HF临床结局方面有效性的证据。
通过系统的文献检索找到符合条件的研究。仅纳入招募HF患者并将其分配至DMP或常规护理（UC）的随机对照试验（RCT）。收集有关研究背景和设计、参与者特征以及所测试干预措施的信息。进行研究质量评估。评估的主要临床结局包括：全因死亡率和（再）住院率、HF相关（再）住院率和死亡率。根据Yusuf-Peto方法和随机效应模型进行荟萃分析。
纳入33项RCT。与UC相比，DMP显著降低了死亡率：OR = 0.80（CI 0.69 - 0.93，p = 0.003）。全因和HF相关住院率也显著降低：分别为OR = 0.76（CI 0.69 - 0.94，p < 0.00001）和OR = 0.58（CI 0.50 - 0.67，p < 0.00001）。不同的DMP方法似乎同样有效（敏感性分析）。
DMP可降低HF患者的死亡率和住院率。由于各种类型的DMP似乎同样有效，特定项目的选择取决于当地卫生服务特点、患者群体和可用资源。
