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Editorial
Heart failure disease management programmes: a new paradigm for research
  1. Alexander M Clark1,
  2. David R Thompson2
  1. 1Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
  2. 2Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
  1. Correspondence to Professor Alex M Clark, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta T63 2G3, Canada; alex.clark{at}ualberta.ca

https://doi.org/10.1136/heartjnl-2012-302572

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    “The transition from a paradigm in crisis to a new one … changes some of the field's most elementary theoretical generalizations as well as many of its paradigm methods and applications.”Thomas S Kuhn.1

    Few areas of non-pharmacological research have had as much study or success as heart failure disease management programmes (HFDMPs). The first pioneering trial published 17 years ago has been followed by over 60 randomised trials and 15 meta-analyses of home, hospital or telehealth interventions.2 Thirteen of these reviews identified 15%–20% improvements in all-cause mortality, nine identified 30%–56% improvements in HF-related hospitalisation, and 10 identified reductions in all-cause readmission of 15%–25%.2 Accordingly, guidelines recommended HFDMPs widely and enthusiastically.3 The effectiveness of these non-pharmacological interventions appears assured.

    The crisis paradigm: dismissing anomalies and pressing ahead

    Thomas Kuhn famously argued that periods of relative stability in science, known as ‘Normal Science’, are characterised by such consistent successes.1 However, these periods of scientific successes are frequently disturbed by anomalies that cannot be explained using the very approaches that produced past successes.1

    Indeed, in recent years, a series of comparatively large and high-quality trials have found no or small benefits from different kinds of HFDMPs.4 Recently, the Medicare Health Support Pilot Program trial of over 250 000 patients achieved only small improvements in a third of the outcomes measured, and identified that commercial disease management programmes for patients …

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    Footnotes

    • Both people listed above as authors fulfil the criteria for authorship.

    • Article provenance The authors have been leading research into the complexities of heart disease, including heart failure, for decades. In recent years, this work has drawn on complexity theory to raise concerns about the sophistication of the evidence base informing research into disease management programmes, particularly for people with heart failure. This work has been published in the Lancet, Journal of American College of Cardiology and European Journal of Heart Failure. Clark is guarantor.

    • Competing interests None.

    • Provenance and peer review Not commissioned; internally peer reviewed.