TY - JOUR
T1 - Transitional care interventions to prevent readmissions for persons with heart failure
T2 - A systematic review and meta-analysis
AU - Feltner, Cynthia
AU - Jones, Christine D.
AU - Cené, Crystal W.
AU - Zheng, Zhi Jie
AU - Sueta, Carla A.
AU - Coker-Schwimmer, Emmanuel J L
AU - Arvanitis, Marina
AU - Lohr, Kathleen N.
AU - Middleton, Jennifer C.
AU - Jonas, Daniel E.
PY - 2014/6/3
Y1 - 2014/6/3
N2 - 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.
AB - 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.
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U2 - 10.7326/M14-0083
DO - 10.7326/M14-0083
M3 - Review article
C2 - 24862840
AN - SCOPUS:84901795744
SN - 0003-4819
VL - 160
SP - 774
EP - 784
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 11
ER -