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. 2011 Aug 30;2011:0204.
Ref (type) Population Outcome, Interventions Results and statistical analysis Effect size Favours
All-cause mortality
[15]
Systematic review
5308 people
28 RCTs in this analysis
Rate of all-cause mortality
389/2587 (15%) with disease management programme
492/2721 (18%) with usual care

OR 0.80
95% CI 0.69 to 0.93
P = 0.003
RCTs of multidisciplinary treatment were generally small, involving highly selected patient populations (see further information on studies for more details)
Small effect size disease management programme
[16]
Systematic review
Number of people in analysis not reported
30 RCTs in this analysis
Rate of all-cause mortality
with disease management programme
with usual care
Absolute results not reported

ARR –3%
95% CI –5% to –1%
P <0.01
Benefit of the intervention was dependent on age, severity of disease, guideline-based treatment at baseline, and disease management programme modalities
Effect size not calculated disease management programme
[17]
Systematic review
7532 people
27 RCTs in this analysis
Rate of all-cause mortality
613/3867 (16%) with multidisciplinary programme
661/3580 (18%) with control (not further defined)

RR 0.79
95% CI 0.69 to 0.92
P = 0.002
There was significant heterogeneity among RCTs (P = 0.04); the review identified 2 RCTs that were outliers as potential sources of heterogeneity
Small effect size multidisciplinary programme
[17]
Systematic review
7213 people
26 RCTs in this analysis
Sensitivity analysis
Rate of all-cause mortality
with multidisciplinary programme
with control (not further defined)
Absolute results not reported

RR 0.83
95% CI 0.73 to 0.95
P = 0.002
Sensitivity analysis excluding 1 outlier removed heterogeneity with only a small reduction in results for effectiveness
Small effect size multidisciplinary programme
[17]
Systematic review
553 people
3 RCTs in this analysis
Subgroup analysis
Rate of all-cause mortality
35/316 (11%) with televideo or remote monitoring-based programme
51/237 (22%) with control (not further defined)

RR 0.49
95% CI 0.33 to 0.73
P = 0.0004
Moderate effect size televideo or remote monitoring-based programme
[17]
Systematic review
3384 people
11 RCTs in this analysis
Subgroup analysis
Rate of all-cause mortality
220/1679 (13%) with programmes incorporating contact by telephone or mail
279/1705 (16%) with control (not further defined)

RR 0.70
95% CI 0.53 to 0.94
P = 0.02
Small effect size programmes incorporating contact by telephone or mail
[17]
Systematic review
1811 people
11 RCTs in this analysis
Subgroup analysis
Rate of all-cause mortality
149/890 (17%) with programmes consisting of home visits
183/921 (20%) with control (not further defined)

RR 0.87
95% CI 0.72 to 1.06
P = 0.17
Not significant
[17]
Systematic review
1784 people
3 RCTs in this analysis
Subgroup analysis
Rate of all-cause mortality
209/982 (21.3%) with programmes delivered in hospital, clinic, or general practice
170/802 (21.2%) with control (not further defined)

RR 1.00
95% CI 0.84 to 1.20
P = 0.98
Not significant
[18]
Systematic review
3918 people
22 RCTs in this analysis
Rate of all-cause mortality
with multidisciplinary programmes
with control (predominantly usual care)
Absolute results not reported

OR 0.69
95% CI 0.56 to 0.85
Small effect size multidisciplinary programme
[18]
Systematic review
Number of RCTs and people included in subgroup analysis not reported
Subgroup analysis
Rate of all-cause mortality
with programmes involving face-to-face contact
with control (predominantly usual care)
Absolute results not reported

OR 0.63
95% CI 0.44 to 0.91
Small effect size programmes involving face-to-face contact
[18]
Systematic review
Number of RCTs and people included in subgroup analysis not reported
Subgroup analysis
Rate of all-cause mortality
with programmes involving face-to-face contact plus telephone contact
with control (predominantly usual care)
Absolute results not reported

OR 0.68
95% CI 0.44 to 1.06
Not significant
[18]
Systematic review
Number of RCTs and people included in subgroup analysis not reported
Subgroup analysis
Rate of all-cause mortality
with programmes involving telephone (non face-to-face) management
with control (predominantly usual care)
Absolute results not reported

OR 0.82
95% CI 0.48 to 1.40
Not significant
[19]
Systematic review
2060 people
12 RCTs in this analysis
Rate of all-cause mortality
117/1001 (12%) with pharmacist care
136/1059 (13%) with no pharmacist care

OR 0.84
95% CI 0.61 to 1.15
Not significant
[20]
Systematic review
6133 people
19 RCTs in this analysis
All-cause mortality
390/3320 (12%) with remote patient monitoring
397/2813 (14%) with usual care

RR 0.83
95% CI 0.73 to 0.95
P = 0.006
Small effect size remote patient monitoring
[21]
Systematic review
5563 people
15 RCTs in this analysis
All-cause mortality
332/2948 (11%) with structured telephone support
332/2615 (13%) with usual care

RR 0.88
95% CI 0.76 to 1.01
P = 0.08
Not significant
[21]
Systematic review
2710 people
11 RCTs in this analysis
All-cause mortality
147/1410 (10%) with telemonitoring
200/1300 (15%) with usual care

RR 0.66
95% CI 0.54 to 0.81
P = 0.00005
Small effect size telemonitoring
[22]
RCT
3-armed trial
1049 people hospitalised because of heart failure, New York Heart Association (NYHA) functional class II to IV Rate of all-cause mortality 18 months
83/344 (24%) with intensive disease management programme
99/339 (29%) with usual care

Significance not assessed
The RCT was not powered to assess mortality alone
The results from this large RCT do not correlate with the results of the 6 systematic reviews reported (see further information on studies for details)
[23]
RCT
1518 people having outpatient care for stable chronic heart failure with mainly NYHA class II or III symptoms All-cause mortality up to 1 year after completion of the trial
189/760 (25%) with previous telephone monitoring by specialised nurses
197/758 (26%) with previous usual care

RR 0.94
95% CI 0.77 to 1.16
P = 0.59
Not significant
[23]
RCT
1518 people having outpatient care for stable chronic heart failure with mainly NYHA class II or III symptoms All-cause mortality up to 3 years after completion of the trial
326/760 (43%) with previous telephone monitoring by specialised nurses
308/758 (41%) with previous usual care

RR 1.02
95% CI 0.87 to 1.20
P = 0.73
Not significant