Effect of Educational Interventions to Reduce Readmissions due to Heart Failure Decompensation in Adults: a Systematic Review and Meta-analysis

Cañón-Montañéz, Wilson; Duque-Cartagena, Tatiana; Acelas, Alba Luz Rodríguez

doi:10.17533/udea.iee.v39n2e05

Cited by 6 publications

(11 citation statements)

References 58 publications

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“…Of the eight systematic reviews [20][21][22][23][24][25][26][27] , six included a meta-analysis of the impact on HF readmissions, [20][21][22][23][24][25] six examined all-cause readmissions, 20,[22][23][24][26][27] five investigated all-cause mortality outcomes, 20,23,24,26,27 and two reviews examined HF mortality. 20,24 The full details of each systematic 1332 review are provided in Supporting Information, Table S2.…”

Section: Resultsmentioning

confidence: 99%

“…This narrative meta-synthesis is the first review to analyse the outcomes of DSMS interventions based on intervention intensity. The findings suggest that DSMS programmes can significantly reduce acute care readmissions [20][21][22][23][24]26,27 and improve survival. 20,23,24,26,27 Although low-intensity DSMS programmes have some influence on HF readmissions, we found little evidence of their impact on mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of this meta-synthesis underscore the lack of evidence to evaluate the effectiveness of DSMS programmes applied to diverse settings and the necessity of a better understanding of the key elements of effective DSMS programmes, so they can be applied to a local context. [20][21][22][23][24][25][26][27] In lower middle-income countries, patients often need more clinician support to self-monitor and respond to changing symptoms. Subtle and substantial differences between programmes have implications in terms of not only effectiveness but also feasibility related to resources required and cultural acceptance.…”

Section: Discussionmentioning

confidence: 99%

“…Five of the six systematic reviews found an overall reduction in HF readmissions [20][21][22][23][24] (Table 2). This evidence was generated from 92 (66.7%) unique studies measuring HF readmission, with 35.9% (n = 33) showing a positive benefit.…”

Section: Acute Care Readmissionmentioning

confidence: 99%

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Narrative synthesis of the effectiveness and characteristics of heart failure disease self‐management support programmes

Koontalay,

Botti,

Hutchinson

2024

ESC Heart Failure

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A deeper understanding of the key elements that should be included in heart failure (HF) disease self‐management support (DSMS) programmes is crucial to enhance programme effectiveness and applicability to diverse settings. We investigated the characteristics and effectiveness of DSMS programmes designed to improve survival and decrease acute care readmissions for people with HF and determine the generalizability and applicability of the evidence to low‐ and middle‐income countries (LMICs). A narrative meta‐synthesis approach was used, and systematic reviews of randomized controlled trials (RCTs) of DSMS programmes were included. The Cochrane Database of Systematic Reviews, MEDLINE, and Embase were searched without language restriction and guided by the adapted Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Eight high‐quality systematic reviews were identified representing 250 studies, of which 138 were unique RCTs measuring the outcomes of interest. The findings revealed statistically significant reductions in HF readmissions [relative risk (RR) range 0.64–0.85, P < 0.5, five out of six reviews], all‐cause readmissions (RR range 0.85–0.95, P < 0.5, five out of six reviews), and all‐cause mortality (RR range 0.67–0.87, P < 0.5, five out of five reviews). Overall, 44.2% (n = 61) of RCTs reduced acute care readmission and improved survival. Studies were categorized according to intensity (low, moderate, moderate+, and high) based on the opportunity for immediate treatment of HF instability; 29.2% (14/48) of low‐intensity, 63.6% (21/33) of moderate‐intensity, 40% (6/15) of moderate+‐intensity, and 47.6% (20/42) of high‐intensity interventions were effective. Most effective programmes used moderate‐intensity (39.4%, 48%, or 50%, respectively) or high‐intensity (33.3%, 36%, and 43.7%, respectively) interventions. The majority of studies (90.6%) were conducted in high‐income countries. Programmes that provided opportunities for early recognition and response to HF instability were more likely to reduce acute care readmission and enhance survival. Generalizability and applicability to LMICs are clearly limited. Tailoring HF DSMS programmes to accommodate cultural, resource, and environmental challenges requires careful consideration of intervention intensity, duration of follow‐up, and feasibility in low‐resource settings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Acute Care Readmissionmentioning

confidence: 99%

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Narrative synthesis of the effectiveness and characteristics of heart failure disease self‐management support programmes

Koontalay,

Botti,

Hutchinson

2024

ESC Heart Failure

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“…A systematic review and meta-analysis of 47 studies reported the success of home-visiting programs and multidisciplinary HF clinics in reducing all-cause readmission and mortality, and of structured telephone support in reducing HF-specific readmission and mortality [ 60 ]. Similarly, results from another systematic review and meta-analysis highlight the importance of educational interventions on HF in reducing readmissions and length of hospital stay in adults with HF [ 61 ]. Many of these educational interventions, however, were implemented by experienced cardiovascular nurses.…”

Section: Main Textmentioning

confidence: 99%

Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post–hospital discharge period

Butler

Petrie

Bains³

et al. 2023

Res Involv Engagem

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Background People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF. Methods This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post–hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article. Results Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations. Conclusion Numerous challenges continue to affect people living with HF in the post–hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.

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Effectiveness of Heart Failure Checklist Management in Patients with Chronic Heart Failure: An Open-Label, Single-Center Controlled Study During 18 Months of Follow-Up

Xu,

Cheng,

Zhang

et al. 2023

TCRM

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The efficacy of chronic heart failure (CHF) checklist management in reducing adverse outcomes of heart failure patients is still uncertain. This study explores whether CHF checklist management is more useful than usual care in reducing adverse health outcomes in the medium-and long-term among CHF patients. Methods: In our prospective study, 132 patients with CHF were randomly assigned to CHF management group and usual care group by random number method. Patients in CHF management group were conducted through CHF checklist by cardiologists and general practitioner. Patients assigned to usual care were treated by non-stationary medical group without checklist. All groups were followed up for 18 months. Results: There was no significant difference in overall mortality rate between management group and control group during 18 months (12.3% [8/65] vs. 11.7% [7/60], P = 0. 912]). The re-hospitalization rate of heart failure in management group (18.5% [12/65]) was significantly lower than that in usual care group (38.3% [23/60]) after 18 months of follow-up (P = 0.013). Median NT-proBNP level (632.3 ng/l vs. 1678 ng/l, p = 0.004) was lower in management group than that in usual care group. Cardiac ultrasonography was performed at 18 months between the management and usual care group. LVEDD (55.88±7.11 mm vs. 60.92±8.06 mm) and LVESD (43.25±8.42mm vs. 48.41± 9.02mm) were decreased (P<0.01). LVEF was increased (45.36±10.64% vs. 39.96 ±10.15%, P<0.01). The utilization rate of ACEI/ARB/ARNI, β-blocker were high in management group. Conclusion: CHF checklist management by cardiologists and general practitioners can significantly reduce the re-hospitalization and improve cardiac function. CHF management through heart failure checklist may improve prognosis in patients with CHF in the medium-and long-term.

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Effect of Educational Interventions to Reduce Readmissions due to Heart Failure Decompensation in Adults: a Systematic Review and Meta-analysis

Cited by 6 publications

References 58 publications

Narrative synthesis of the effectiveness and characteristics of heart failure disease self‐management support programmes

Narrative synthesis of the effectiveness and characteristics of heart failure disease self‐management support programmes

Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post–hospital discharge period

Effectiveness of Heart Failure Checklist Management in Patients with Chronic Heart Failure: An Open-Label, Single-Center Controlled Study During 18 Months of Follow-Up

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