RT Journal Article
SR Electronic
T1 Does self-management support increase the risk of mortality amongst patients with COPD? A systematic review of the evidence
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4737
VO 44
IS Suppl 58
A1 Rachel Jordan
A1 Saimma Majothi
A1 Nicola Heneghan
A1 Richard Riley
A1 Alice Sitch
A1 Malcolm Price
A1 Elizabeth Bates
A1 Alice Turner
A1 Sue Bayliss
A1 David Moore
A1 Sally Singh
A1 Peymane Adab
A1 David Fitzmaurice
A1 Kate Jolly
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P4737.abstract
AB IntroductionSelf-management support is recommended worldwide for patients with COPD, although interventions are heterogeneous and evidence of their effectiveness is inconsistent. A large RCT was stopped prematurely because of increased mortality among patients in the self-management arm. We undertook a broad, comprehensive systematic review to evaluate whether self-management support increases mortality.MethodsRCTs were sought to May 2012: population: patients with COPD; intervention: any intervention including self-management components compared with usual care/control; outcome: all-cause mortality; duration: >24 weeks. Pooled estimates of hazard ratios were obtained from random effects meta-analysis.ResultsFrom 13477 records, 44 RCTs reported 447 deaths among 5522 patients. Trials varied in size (n=26 to n=743), intervention (from single components to integrated care) and generally had few events. Overall there was no clear evidence of a difference in mortality, although the point estimate favoured the self-management interventions (HR 0.90 (95%CI 0.74, 1.09)). Sub-group analyses among trials of patients with more severe disease, prior admissions (HR 0.93 (0.72, 1.19)) or provision of action plans (HR 0.89 (0.70, 1.12)) did not differ. However, interventions with the most scheduled contact with healthcare professionals (HCP) showed reduced mortality (HR 0.72 (0.55, 0.95)). I2=0% (no heterogeneity) for all results.ConclusionThere is no evidence that self-management support increases mortality. Only the most supported interventions (eg disease/case management/home rehabilitation) with substantial scheduled contact with HCP may reduce mortality.