Letter to the Editor| Volume 19, ISSUE 12, P1143-1146, December 2018

Letter by Fung et al Regarding Article, “Frailty and Clinical Outcomes in Heart Failure: A Systematic Review and Meta-analysis”

Published:November 01, 2018DOI:
      The following two letters consist of a critique and author's reply related to an article in this month's journal, which was published online early enough to obtain both the letter and reply in time to publish all three simultaneously. The letter by Fung et al raises legitimate questions about the conduct and interpretation of data in a systematic review and meta-analysis, which the response by Zhang et al addresses point-by-point. Taken together, these correspondences illustrate many of the challenges inherent in conducting a comprehensive and valid systematic review and meta-analysis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zhang Y.
        • Yuan M.
        • Gong M.
        • et al.
        Frailty and clinical outcomes in heart failure: A systematic review and meta-analysis.
        J Am Med Dir Assoc. 2018; 19: 1003-1008
        • Reeves G.R.
        • Whellan D.J.
        • Patel M.J.
        • et al.
        Comparison of frequency of frailty and severely impaired physical function in patients ≥60 years hospitalized with acute decompensated heart failure versus chronic stable heart failure with reduced and preserved left ventricular ejection fraction.
        Am J Cardiol. 2016; 117: 1953-1958
        • Jha S.R.
        • Hannu M.K.
        • Newton P.J.
        • et al.
        Reversibility of frailty after bridge-to-transplant ventricular assist device implantation or heart transplantation.
        Transplant Direct. 2017; 3: e167
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • et al.
        • ESC Scientific Document Group
        2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2200
        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • et al.
        2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.
        Circulation. 2017; 136: e137-e161
        • Rich M.W.
        • Chyun D.A.
        • Skolnick A.H.
        • et al.
        American Heart Association Older Populations Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council; American College of Cardiology; and American Geriatrics Society. Knowledge gaps in cardiovascular care of the older adult population: A scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society.
        J Am Coll Cardiol. 2016; 67: 2419-2440
        • McDonagh J.
        • Ferguson C.
        • Newton P.J.
        Frailty assessment in heart failure: An overview of the multi-domain approach.
        Curr Heart Fail Rep. 2018; 15: 17-23
      1. Eden J, Levit L, Berg A, Morton S, eds. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: Institute of Medicine, the National Academies Press, 2011. Available at: Accessed August 24, 2018.

        • Senn S.J.
        Overstating the evidence: double counting in meta-analysis and related problems.
        BMC Med Res Methodol. 2009; 9: 10

      Linked Article

      • Reply to the Letter to Editor
        Journal of the American Medical Directors AssociationVol. 19Issue 12
        • Preview
          We read with great delight the letter concerning our recently published systematic review and meta-analysis on frailty and clinical outcomes in heart failure.1 First, we thank the authors for reading our manuscript in detail and for expressing their critical comments. Second, these authors should be commended for going to great lengths seeking responses from the authors of the original studies. Third, their use of 6 colors (excluding black) in their Table 1 facilitated the readership for understanding the different aspects of their text.
        • Full-Text
        • PDF