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May 1, 2002

Treatment of Congestive Heart Failure

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(17):2209-2210. doi:10.1001/jama.287.17.2209

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.

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