Ensayos aleatorios de los programas de prevención secundaria de la enfermedad coronaria: revisión sistemática

CRD COMMENTARY:

This paper was clearly written and it provided a good description of the methods used in the review. The literature sources searched were comprehensive. The authors used a broad definition of disease management programmes. However, the inclusion criteria for these interventions were not defined clearly, and this makes it difficult to identify how these programmes differ from studies of other comprehensive cardiac rehabilitation programmes. The information about the components of the disease management programmes (and of the control treatments) in the individual studies was limited. This, and the acknowledged highly selected populations in the studies, means that it is difficult to generalise from the results. Other details of the primary studies were well presented. The included studies were not assessed for quality and, given the nature of the intervention, it is probable that none were blinded. The meta-analyses would seem to have been appropriate. However, the results of the heterogeneity tests were not reported. A sensitivity analysis that excluded the three trials of participants with diagnoses other than 'CHD' would have been interesting. The review included a range of disease management programmes, and it is difficult to identify from this analysis which programmes might offer the most benefit.
Overall, and bearing the above comments in mind, the authors' conclusions would seem to be supported by the results presented.