Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta‐analysis

Abstract

Nurse home visits and DMCs decrease all-cause mortality after hospitalization for HF. Along with NCM, they also reduce all-cause readmissions, with no significant difference in comparative effectiveness. These services reduce healthcare system costs to varying degrees.

Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

“…In our study, the delay between discharge and the first outpatient visit was not recorded, but it must be pointed out that 12% of our patients had no consultation during the 3 months following discharge. Other transitional care service strategies, including followup phone calls, visiting nurses, telemonitoring, and home weight monitoring have shown some usefulness [27]. Therefore it should be possible to achieve target doses of key medications and improve symptoms without adversely affecting side effect symptoms, electrolytes or renal function.…”

Applying Heart Failure Management to Improve Health Outcomes: But WHICH One?

“…22 Consistent with the most recent reviews, 5,6 we continue to recommend that HF management programmes apply at least one home visit post-hospitalisation as part of the nurse-led multidisciplinary management of the syndrome.…”

“…One of the key challenges to further enhance the benefits of our model of HF management (HBI) is the possibility of a 'threshold effect', whereby additional holistic support, surveillance and advice (with the prospect of invoking the previously described phenomenon of a counter-productive 'clinical cascade' effect) 26 5 However, as noted, our research suggests that the effects of a HBI are not consistent amongst all patient groups, with age and multimorbidities co-influencing outcomes. 27 We propose that this phenomenon be described as the 'goldilocks effect', where HF patients may be divided into three categories: simple, complex and highly symptomatic.…”

“…1,2 Latest expert guidelines 3,4 confirmed by meta-analyses 5,6 support the application of multidisciplinary HF management programs to improve health outcomes. These programmes, built on a patient-centric model of care, 7 involve a congruent coordination of healthcare interventions specifically designed to optimise the management of individuals with HF.…”

Bringing order to chaos: the case for integrated management of atrial fibrillation

“…The first wave of epidemiological change saw the emergence of heart failure (HF) as a substantive public health issue 1. Beyond pharmacological agents and devices, a large body of evidence now supports the application of predominantly nurse-led, multidisciplinary management programmes to address high levels of morbidity and mortality in that patient population; with home-based models of care seemingly more effective than other modes in delivering what are essentially the same components of care 2. The second wave of epidemiological change (reflecting subtle but important differences in the natural history of HF and atrial fibrillation (AF)) saw the emergence of AF as a compounding burden of disease within our ageing populations 3.…”