Heart Care Info - Heart Disease Prevention & Treatment

Meta Analysis of Outpatient Heart Failure Patient Management Interventions

B Wakefield, B Wakefield, P Groves, V Conn... - 2011 - Meta Analysis of Outpatient Heart Failure Patient Management Interventions Conference Sponsor: Midwest Nursing Research Society Conference Year: 2010 Author: Wakefield, Bonnie, Ph D, RN PI Institution Name: University of Missouri Title: Sinclair School of ...

Chronic heart failure (HF) is one of the most common reasons for hospitalization in older individuals. Current evidence-based HF guidelines focus primarily on optimal use of medications with less emphasis on daily self management. The objective of this study is to determine the effectiveness of extant patient self-management interventions to provide a basis for development of evidence-based HF patient self-management programs. The research questions are: What are the overall effects of self-management programs on readmission, mortality, quality of life, and costs outcomes; and Do intervention effects vary depending on intervention or sample characteristics? The study is in progress and will employ a meta-analysis approach. A search of the Medline electronic database was conducted using 10 keywords (e.g., heart failure, home care services, monitoring ambulatory). The search was limited to randomized controlled trials (RCT) with a true control group (e.g., studies of multiple treatments with no control group were excluded). After establishing inter-rater reliability, three reviewers coded 40 RCT reports published since 1995. Analysis plans include: d-index to standardize the magnitude of effect, sample size weighted calculations, random-effects models, homogeneity (Q) assessment, and publication bias analysis. Analyses will be conducted separately for the most commonly measured outcomes (readmission, mortality, quality of life, costs). Exploratory moderator analyses using meta-analysis analogues of regression and ANOVA will reveal which intervention characteristics are associated with larger effect sizes for heart failure outcomes. Home telemonitoring using scripted content is becoming widespread in the United States. Development of content for these programs is often driven by device manufacturers. However development of standardized evidence-based programs using components shown to be successful is crucial to implementation of effective telehealth-based interventions.