RT Journal
A1 Jerant AF
T1 TReatment of congestive heart failure
JF JAMA
JO JAMA
YR 2002
FD May 1
VO 287
IS 17
SP 2209
OP 2210
DO 10.1001/jama.287.17.2209
UL http://dx.doi.org/10.1001/jama.287.17.2209
AB 
To the Editor: Dr Nohria and colleagues1 provide no evidence for their conclusion that heart
failure hospitalization rates "are reliably decreased by experienced heart
failure physician-nurse teams making decisions but not by centralized nursing
services providing patient contact but no intervention except through multiple
primary providers." We believe that the meta-analysis2
they cited in support of this conclusion is flawed. One3
of the 2 studies in the meta-analysis that was categorized as evaluating telephonic
"centralized nursing services" to enhance primary care follow-up did not even
focus on a heart failure disease management program. Instead, patients in
the Veterans Affairs (VA) health care system with a variety of chronic illnesses
received global primary care clinician and nursing support. Second, the patients
in the VA study had higher comorbidity and lower baseline quality of life
scores than patients in the other studies included in the meta-analysis. Third,
the authors of the VA study acknowledged that many factors unique to the VA
system may have influenced their findings and thus would limit their generalizability
to other health care systems. The appropriateness of quantitatively combining
data from this study with the others is questionable, regardless of the results
of heterogeneity testing.