The effectiveness of chronic care management for heart failure: meta-regression analyses to explain the heterogeneity in outcomes.

OBJECTIVE To support decision making on how to best redesign chronic care by studying the heterogeneity in effectiveness across chronic care management evaluations for heart failure. DATA SOURCES Reviews and primary studies that evaluated chronic care management interventions. STUDY DESIGN A systematic review including meta-regression analyses to investigate three potential sources of heterogeneity in effectiveness: study quality, length of follow-up, and number of chronic care model components. PRINCIPAL FINDINGS Our meta-analysis showed that chronic care management reduces mortality by a mean of 18 percent (95 percent CI: 0.72-0.94) and hospitalization by a mean of 18 percent (95 percent CI: 0.76-0.93) and improves quality of life by 7.14 points (95 percent CI: -9.55 to -4.72) on the Minnesota Living with Heart Failure questionnaire. We could not explain the considerable differences in hospitalization and quality of life across the studies. CONCLUSION Chronic care management significantly reduces mortality. Positive effects on hospitalization and quality of life were shown, however, with substantial heterogeneity in effectiveness. This heterogeneity is not explained by study quality, length of follow-up, or the number of chronic care model components. More attention to the development and implementation of chronic care management is needed to support informed decision making on how to best redesign chronic care.