Level 1 Evidence NHMRC – Systematic Review
This systematic review conducted by Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M, (2012) sourced twenty-ﬁve trials, and the overall number of people of the collective trials included was 5,942. Interventions were classified and assessed using the following headings.-
Takeda, Taylor, Khan, Krum, & Underwood. (2012) states ‘(1) case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits); (2) clinic interventions (follow up in a CHF clinic) and (3) multidisciplinary interventions (holistic approach bridging the gap between hospital admission and discharge home delivered by a team). The components, intensity and duration of the interventions varied, as did the ‘usual care’ comparator provided in different trials’. (P. 2).
The systematic review indicated (1) ‘Case management interventions were associated with reduction in all-cause mortality at 12 months follow up, but not at six months’. (Takenda, et al, 2012) The systematic review also went on to state that while case management interventions were not associated with reduced mortality, case management interventions were indicated to reduce the occurrence of patients presenting to hospital with exasperations of chronic heart failure. The benefits of case management based interventions were apparent after 12 months had lapsed. Six of the twenty five studies assessed (2) heart failure clinics, and the evidence for this intervention was less convincing with the review stating ‘there was no real difference in all-cause mortality, readmissions for HF or between patients who attended a clinic and those who received usual care’. (Takenda, et al., 2012)
Lastly (3) multidisciplinary interventions were assessed by the review, two of the 25 studies were included. There were slightly fewer deaths from any cause in the treatment group than in the usual care group, and both all cause and heart failure related readmissions were substantially lower for patients receiving multidisciplinary care. ‘Multidisciplinary interventions may be effective in reducing both CHF and all cause readmissions. There is currently limited evidence to support interventions whose major component is follow up in a CHF clinic’. (Takenda, et al., 2012).
Annotated Bibliography Research Paper 2
Faris RF, Flather M, Purcell H, Poole-Wilson PA, Coats AJS. Diuretics for heart failure. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD003838. DOI: 10.1002/14651858.CD003838.pub3.
Level 1 Evidence NHMRC – Systematic Review-Diuretics are often if not always prescribed In CHF; they have an ability to removed excess fluid from the body and thus reduce symptoms of CHF. Small randomised control trials have provided evidence for prescribers of the effectiveness of diuretics to reduce mortality and exasperations of CHF. The review states ‘About 80 deaths may be avoided for every 1000 people...