Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Anpassung von ACE‐Hemmern, Beta‐Blockern und Angiotensin‐Rezeptorblockern durch Pflegende bei Patienten mit Herzinsuffizienz mit reduzierter Auswurfleistung

Información

DOI:
https://doi.org/10.1002/14651858.CD009889.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 21 diciembre 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Corazón

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

  • Andrea Driscoll

    Correspondencia a: School of Nursing and Midwifery, Deakin University, Geelong, Australia

    [email protected]

  • Judy Currey

    School of Nursing and Midwifery, Deakin University, Geelong, Australia

  • Andrew Tonkin

    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

  • Henry Krum

    Department of Epidemiology & Preventive Medicine, Monash University/The Alfred Hospital, Melbourne, Australia

Contributions of authors

All review authors contributed to the conception and design of the protocol. All review authors provided input into the draft of the review and approved the final review.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • NHMRC, Australia.

    NHMRC postdoctoral fellowship

  • Cochrane Heart Group, UK, Not specified.

    Search strategy and primary eletronic searching of databases

Declarations of interest

Andrea Driscoll, the lead author of this review, was also the lead author of the included study Driscoll 2014. Andrea Driscoll was not involved in the screening and assessment of risk of bias and GRADE for this study.

Acknowledgements

None

Version history

Published

Title

Stage

Authors

Version

2015 Dec 21

Nurse‐led titration of angiotensin converting enzyme inhibitors, beta‐adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure with reduced ejection fraction

Review

Andrea Driscoll, Judy Currey, Andrew Tonkin, Henry Krum

https://doi.org/10.1002/14651858.CD009889.pub2

2012 Jun 13

Nurse‐led titration of angiotensin converting enzyme inhibitors, beta‐adrenergic blocking agents and angiotensin receptor blockers for patients with left ventricular systolic dysfunction

Protocol

Andrea Driscoll, Judy Currey, Andrew Tonkin, Henry Krum

https://doi.org/10.1002/14651858.CD009889

Differences between protocol and review

We changed the term 'left ventricular systolic dysfunction' to 'heart failure with reduced ejection fraction (HFrEF)'.

We included all‐cause mortality as a primary outcome.

We modified the primary outcome of all‐cause or heart failure related event free survival to all‐cause event‐free survival.

We modified the secondary outcome of 'achieved dose as a percentage of target dose' to 'proportion reaching target dose of medications'.

We have reworded the Types of studies section to accurately reflect with what the intervention was compared.

We did not search CINAHL as planned due to access problems.

We did not create funnel plots due to the low number of included studies.

We included a 'Summary of findings' table in the review.

We have listed all‐cause hospital admissions and heart failure‐related hospital admissions as separate outcomes.

We did not undertake a subgroup analysis of the proportion of participants receiving optimal dose of ACEIs and ARBs due to a lack of studies reporting on this outcome.

We did not undertake a subgroup analysis of patients managed by a heart failure nurse but titration of medications by other health professionals as there were no RCTS investigating this intervention.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Nurse‐led titration versus usual care, Outcome 1 All‐cause hospital admissions.
Figuras y tablas -
Analysis 1.1

Comparison 1 Nurse‐led titration versus usual care, Outcome 1 All‐cause hospital admissions.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Nurse‐led titration versus usual care, Outcome 2 Heart failure‐related hospital admissions.
Figuras y tablas -
Analysis 1.2

Comparison 1 Nurse‐led titration versus usual care, Outcome 2 Heart failure‐related hospital admissions.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Nurse‐led titration versus usual care, Outcome 3 All‐cause mortality.
Figuras y tablas -
Analysis 1.3

Comparison 1 Nurse‐led titration versus usual care, Outcome 3 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Nurse‐led titration versus usual care, Outcome 4 All‐cause event free survival.
Figuras y tablas -
Analysis 1.4

Comparison 1 Nurse‐led titration versus usual care, Outcome 4 All‐cause event free survival.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Nurse‐led titration versus usual care, Outcome 5 Proportion reaching target dose of medications.
Figuras y tablas -
Analysis 1.5

Comparison 1 Nurse‐led titration versus usual care, Outcome 5 Proportion reaching target dose of medications.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Nurse‐led titration versus usual care for people with heart failure with reduced ejection fraction

Nurse‐led titration versus usual care for people with heart failure with reduced ejection fraction

Patient or population: people with heart failure with reduced ejection fraction
Settings: outpatient clinic, primary care clinic, residential care facility, telephone follow‐up
Intervention: Nurse‐led titration versus usual care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Nurse‐led titration versus usual care

All‐cause hospital admissions
Follow‐up: median 12 months

Study population

RR 0.80
(0.72 to 0.88)

560
(4 studies)

⊕⊕⊕⊕
high

763 per 1000

610 per 1000
(549 to 671)

Moderate

437 per 1000

350 per 1000
(315 to 385)

Heart failure‐related hospital admissions
Follow‐up: median 12 months

Study population

RR 0.51
(0.36 to 0.72)

642
(4 studies)

⊕⊕⊕⊝
moderate3

248 per 1000

126 per 1000
(89 to 178)

Moderate

182 per 1000

93 per 1000
(66 to 131)

All‐cause mortality
Follow‐up: median 12 months

Study population

RR 0.66
(0.48 to 0.92)

902
(6 studies)

⊕⊕⊕⊝
moderate2,3

166 per 1000

110 per 1000
(80 to 153)

Moderate

163 per 1000

108 per 1000
(78 to 150)

All‐cause event‐free survival
Follow‐up: median 12 months

Study population

RR 0.60
(0.46 to 0.77)

370
(3 studies)

⊕⊕⊕⊝
moderate3

487 per 1000

292 per 1000
(224 to 375)

Moderate

385 per 1000

231 per 1000
(177 to 296)

Proportion reaching target dose of medications
Follow‐up: median 12 months

Study population

RR 1.99
(1.61 to 2.47)

966
(5 studies)

⊕⊕⊝⊝
low1,2,3

171 per 1000

340 per 1000
(275 to 422)

Moderate

182 per 1000

362 per 1000
(293 to 450)

*The assumed risk is based on the observed incidence across the pooled control groups. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1,2 I = 68% and P = 0.03 with a high Chi2 in relation to degrees of freedom.
2Two studies had a total sample size of < 25 resulting in wide confidence intervals.
3At least two studies with a high risk of reporting bias.

Figuras y tablas -
Summary of findings for the main comparison. Nurse‐led titration versus usual care for people with heart failure with reduced ejection fraction
Ir a la tabla de la revisión
Comparison 1. Nurse‐led titration versus usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause hospital admissions Show forest plot

4

560

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.72, 0.88]

2 Heart failure‐related hospital admissions Show forest plot

4

642

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.36, 0.72]

3 All‐cause mortality Show forest plot

6

902

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.48, 0.92]

4 All‐cause event free survival Show forest plot

3

370

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.46, 0.77]

5 Proportion reaching target dose of medications Show forest plot

5

966

Risk Ratio (M‐H, Fixed, 95% CI)

1.99 [1.61, 2.47]
Figuras y tablas -
Comparison 1. Nurse‐led titration versus usual care
Ir a la tabla de la revisión