PT  - JOURNAL ARTICLE
AU  - Jordan, Rachel
AU  - Majothi, Saimma
AU  - Heneghan, Nicola
AU  - Riley, Richard
AU  - Sitch, Alice
AU  - Price, Malcolm
AU  - Bates, Elizabeth
AU  - Turner, Alice
AU  - Bayliss, Sue
AU  - Moore, David
AU  - Singh, Sally
AU  - Adab, Peymane
AU  - Fitzmaurice, David
AU  - Jolly, Kate
TI  - Does self-management support increase the risk of mortality amongst patients with COPD? A systematic review of the evidence
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P4737
VI  - 44
IP  - Suppl 58
4099  - https://publications.ersnet.org//content/44/Suppl_58/P4737.short
4100  - https://publications.ersnet.org//content/44/Suppl_58/P4737.full
SO  - Eur Respir J2014 Sep 01; 44
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.