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To the Editor: In their meta-analysis of management of discharge planning for older patients with congestive heart failure, Drs Phillips and colleagues¹ concluded that these programs were associated with an approximately 25% relative reduction in the risk of readmission. We are concerned about the way that the authors categorize the interventions. As primary investigators of 8 of the 18 trials the authors included in their meta-analysis, we believe that these categories obscure true differences among programs.

We also believe that categorization of programs according to the predominant method of intervention is flawed because it incorrectly presumes that every program applies a core set of components with similar intensity. Furthermore, targeted programs that focus on only 1 or 2 management issues (eg, patient education) are different from those that take a more comprehensive approach.

For instance, the study by Jaarsma et al² used a targeted intervention focused on increasing self-care behaviors, . . . [Full Text of this Article]

Barbara Riegel, DNSc, RN, CS; Mary Naylor, PhD, RN
University of Pennsylvania
Philadelphia

Simon Stewart, PhD, RN
National Heart Foundation of Australia
University of South Australia
Adelaide

John J. V. McMurray, BSc, MD, FRCP
Western Infirmary
Glasgow, Scotland

Michael W. Rich, MD
Washington University School of Medicine
St Louis, Mo

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