Case management does not decrease mortality of patients with myocardial infarction or unstable angina: Evidence from a systematic review

Abstract

Objective: To objectively assess the impact of case management on patients with myocardial infarction or unstable angina. Methods: PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database were searched for relevant randomized controlled trials (RCTs) published through February 2015. The quality of eligible studies was independently assessed by two investigators. The primary outcome assessed from included studies was all-cause mortality, with total cholesterol, systolic and diastolic blood pressures, smoking cessation rates and cost-effectiveness as secondary outcomes. The pooled effect sizes were expressed as relative risk, odds risk, and standard mean difference with 95% confidence intervals. Heterogeneity among studies was assessed using Cochrane Q and determined with an I2 statistic. Results: After the initial search, a total of four studies divided into six RCTs that included 1293 participants met the inclusion criteria and were analyzed. The results of meta- and descriptive analyses failed to identify any significant differences in all-cause mortality during the follow-up period of up to 36 months. Furthermore, a definitive conclusion for remaining indicators could not be drawn due to limited evidence. Conclusion: Case management is not beneficial to all-cause mortality after myocardial infarction or unstable angina compared to routine care. Additional, prospective RCTs of high quality and large scale are warranted to verify these results.

Keywords

• Case management
• Meta-analysis
• Myocardial infarction
• Systematic review
• Unstable angina