Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis

Cynthia Feltner*, Christine D. Jones, Crystal W. Cené, Zhi Jie Zheng, Carla A. Sueta, Emmanuel J L Coker-Schwimmer, Marina Arvanitis, Kathleen N. Lohr, Jennifer C. Middleton, Daniel E. Jonas

*Corresponding author for this work

Research output: Contribution to journalReview article

329 Scopus citations

Abstract

Background: Nearly 25% of patients hospitalized with heart failure (HF) are readmitted within 30 days. Purpose: To assess the efficacy, comparative effectiveness, and harms of transitional care interventions to reduce readmission and mortality rates for adults hospitalized with HF. Data Sources: MEDLINE, Cochrane Library, CINAHL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (1 January 1990 to late October 2013). Study Selection: Two reviewers independently selected randomized, controlled trials published in English reporting a readmission or mortality rate within 6 months of an index hospitalization. Data Extraction: One reviewer extracted data, and another checked accuracy. Two reviewers assessed risk of bias and graded strength of evidence (SOE). Data Synthesis: Forty-seven trials were included. Most enrolled adults with moderate to severe HF and a mean age of 70 years. Few trials reported 30-day readmission rates. At 30 days, a high-intensity home-visiting program reduced all-cause readmission and the composite end point (all-cause readmission or death; low SOE). Over 3 to 6 months, home-visiting programs and multidisciplinary heart failure (MDS-HF) clinic interventions reduced all-cause readmission (high SOE). Home-visiting programs reduced HF-specific readmission and the composite end point (moderate SOE). Structured telephone support (STS) interventions reduced HF-specific readmission (high SOE) but not all-cause readmissions (moderate SOE). Home-visiting programs, MDS-HF clinics, and STS interventions produced a mortality benefit. Neither telemonitoring nor primarily educational interventions reduced readmission or mortality rates. Limitations: Few trials reported 30-day readmission rates. Usual care was heterogeneous and sometimes not adequately described. Conclusion: Home-visiting programs and MDS-HF clinics reduced all-cause readmission and mortality; STS reduced HF-specific readmission and mortality. These interventions should receive the greatest consideration by systems or providers seeking to implement transitional care interventions for persons with HF.

Original languageEnglish (US)
Pages (from-to)774-784
Number of pages11
JournalAnnals of internal medicine
Volume160
Issue number11
DOIs
StatePublished - Jun 3 2014

ASJC Scopus subject areas

  • Internal Medicine

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    Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J. L., Arvanitis, M., Lohr, K. N., Middleton, J. C., & Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis. Annals of internal medicine, 160(11), 774-784. https://doi.org/10.7326/M14-0083