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A meta-analysis of “hospital in the home”

To the Editor: Caplan et al1 include in their meta-analysis a trial by Mather et al that compared home care with intensive care management of patients with acute myocardial infarction (AMI) between 1966 and 1968.2 A joint working party of the Royal College of Physicians and British Cardiac Society dismissed the results of this study because of design defects.3,4

Kalra et al5 performed a randomised trial with three arms for patients with acute stroke: stroke unit care, general ward care with stroke team support, and domiciliary care. Stroke units achieved a significantly lower mortality than general ward or domiciliary care. Caplan et al ignore the heterogeneity of the hospital arms, and sum their mortalities, creating a non-existent advantage for domiciliary care over hospital care. This meta-analytic technique is simplistic and invalid.

Hill et al describe home versus hospital management for patients with suspected AMI,2 as do Mather et al.2 Studies of obsolete treatments,…