the other diseases studied. In the area of financial outcomes, there was inconclusive evidence, insufficient evidence, evidence for no effect, or evidence for increased costs. Disease management increased patient satisfaction and health-related quality of life in congestive heart failure and depression, but the evidence was insufficient for the other diseases studied. A subsequent letter to the editor claimed that disease management might nevertheless "satisfy buyers today, even if academics remain unconvinced". A 2008 systematic review and meta-analysis concluded that disease management for COPD "modestly improved exercise capacity, health-related quality of life, and hospital admissions, but not all-cause mortality". A 2009 review of 27 studies "could not draw definitive conclusions about the effectiveness or cost-effectiveness of... asthma disease-management programs" for adults. A Canadian systematic review published in 2009 found that home telehealth in chronic disease management may be cost-saving but that "the quality of the studies was generally low." Researchers from The Netherlands systematically reviewed 31 papers published 2007–09 and determined that the evidence that disease management programs for four diseases reduce healthcare expenditures is "inconclusive." A meta-analysis of randomized trials published through 2009 estimated that disease management for diabetes has "a clinically moderate but significant impact on hemoglobin A1C levels," with an absolute mean difference of 0.51% between experimental and control groups. A 2011 "meta-review" (systematic review of meta-analyses) of heart failure disease management programs found them to be of "mixed quality" in that they did not report important characteristics of the studies reviewed. A 2015 systematic review of randomised controlled trials examining the impact of chronic disease management programmes for adults with asthma, found that having a coordinated program approach with multiple health care professionals compared with usual care can positively impact on the severity of asthma, can improve lung function and also perceived quality of life. Studies not reviewed in the aforementioned papers include the following: A U.K. study published in 2007 found certain improvements in the care of patients with coronary artery disease and heart failure (e.g., better management of blood pressure and cholesterol) if they received nurse-led disease management instead of usual care. In a 2007 Canadian study, people were randomized to receive or not receive disease management for heart failure for a period of six months. Emergency department visits, hospital readmissions, and all-cause deaths were no different in the two groups after 2.8 years of follow-up. A 2008 U.S. study found that nurse-led disease management