Influence of Risk on Reduction of Readmission and Death by Disease Management Programs in Heart Failure

Huynh, Quan; Whitmore, Kristyn; Negishi, Kazuaki; Marwick, Thomas H.

doi:10.1016/j.cardfail.2019.01.015

Cited by 27 publications

(31 citation statements)

References 40 publications

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“…The three domains of detection, attrition, and reporting were generally adequate in all the eight studies. Random sequence generation, allocation concealment, and blinding of data collection were rated to be sufficient strategies in six studies (75%), but these domains were not addressed in two studies [24,31]. Therefore, the risks of bias were not clear in these studies (Figure 3).…”

Section: Study Quality Appraisalmentioning

confidence: 99%

“…Five studies were introduced as multi-component nurse-led self-care education interventions [24,26,28,29,31]. In this review, multi-component self-care education was defined as adding additional strategies such as additional phone calls, clinical assessments, and home visits to promote education.…”

Section: Components Of Heart Failure Self-care Education Interventionsmentioning

confidence: 99%

“…Self-care education combined with phone calls or home visits were the most frequently used strategies in the included studies. One study provided four components: self-care education, phone calls, home visits, and clinical assessment [31]. The duration of intervention varied from 2 weeks to 12 months, and its initiation was categorized as: prior to discharge or within 10~15 days after discharge.…”

Section: Components Of Heart Failure Self-care Education Interventionsmentioning

confidence: 99%

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Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis

Son

Choi

Lee

2020

IJERPH

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Poor self-care behaviors can lead to an increase in the risk of adverse health outcomes among patients with heart failure. Although a number of studies have investigated the effectiveness of nurse-led self-care education, the evidence regarding the effects of nurse-led intervention in heart failure remains uncertain. This study aimed to evaluate evidence on the effectiveness of nurse-led heart failure self-care education on health outcomes in patients with heart failure. To identify studies testing nurse-led education designed to improve self-care among heart failure patients, comprehensive search methods were used between January 2000 and October 2019 to systematically search six electronic databases: PubMed, CINAHL, Embase, Cochrane library, Web of Science, and SCOPUS. All the eligible study data elements were independently assessed and analyzed using random-effects meta-analysis methods. Of 612 studies, eight articles were eligible for this study. Nurse-led heart failure self-care education significantly reduced the risk of all-cause readmission (risk ratio (RR) = 0.75, 95% confidence interval (CI) = 0.66–0.85), heart failure specific readmission (RR = 0.60, 95% CI = 0.42–0.85), and all-cause mortality or readmission (RR = 0.71, 95% CI = 0.61–0.82). However, nurse-led heart failure self-care education was not associated with improvements in the quality of life and heart failure knowledge. Studies on the effectiveness of nurse-led heart failure self-care education mostly report only the positive effects on patients’ health outcomes, whereas evidence of the effectiveness of the nurse-led approach is still limited. Therefore, high quality randomized controlled trials with detailed and explicit descriptions on the components of the interventions are needed.

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Section: Study Quality Appraisalmentioning

confidence: 99%

Section: Components Of Heart Failure Self-care Education Interventionsmentioning

confidence: 99%

Section: Components Of Heart Failure Self-care Education Interventionsmentioning

confidence: 99%

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Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis

Son

Choi

Lee

2020

IJERPH

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“…Depression will be evaluated with Patient Health Questionnaire (PHQ-9) to provide symptom severity, diagnosis, and physical/affective symptoms. The scale has a total score of 27 and scores of 5 or above are indicative of mild (5-9), moderate (10)(11)(12)(13)(14), moderate to severe (15)(16)(17)(18)(19) or severe (20)(21)(22)(23)(24)(25)(26)(27) depression. Patients with abnormal scores of 10 or higher will be referred to the hospital care team to provide further support.…”

Section: Social and Environmental Historymentioning

confidence: 99%

“…3 Application of the DMP-Plus is assumed to reduce admission by 50%. 27 Using a two-sided alpha of 0.05 and statistical power of 0.8, with a 1:1 ratio of intervention to control arms, this study would need 168 patients in Figure 3 Avatar-based HF app. The digital coach (left) provides training that prompts appropriate self-care.…”

Section: Sample Size Calculationmentioning

confidence: 99%

Rationale and design of a risk‐guided strategy for reducing readmissions for acute decompensated heart failure: the Risk‐HF study

et al. 2020

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Aims Heart failure (HF) readmission commonly arises owing to insufficient patient knowledge and failure of recognition of the early stages of recurrent fluid congestion. In previous work, we developed a score to predict short-term hospital readmission and showed that higher-risk patients benefit most from a disease management programme (DMP) that included enhancing knowledge and education by a nurse. We aim to evaluate the effectiveness of a novel, nurse-led HF DMP in selected patients at high risk of short-term hospital readmission, using ultrasound-guided diuretic management and artificial intelligence to enhance HF knowledge in an outpatient setting. Methods and results Risk-HF is a prospective multisite randomized controlled trial that will allocate 404 patients hospitalized with acute decompensated HF, and ≥33% risk of readmission and/or death at 30 days, into risk-guided nurse intervention (DMP-Plus group) compared with usual care. Intervention elements include (i) fluid management with a handheld ultrasound (HHU) device at point of care; (ii) post-discharge follow-up; (iii) optimal programmed drug titration; (iv) better transition of care; (v) intensive self-care education via an avatar-based 'digital health coach'; and (vi) exercise guidance through the digital coach. Usual care involves standard post-discharge hospital care. The primary outcome is reduced death and/or hospital readmissions at 30 days post-discharge, and secondary outcomes include quality of life, fluid management efficacy, and feasibility and patient engagement. Assuming that our intervention will reduce readmissions and/or deaths by 50%, with a 1:1 ratio of intervention vs. usual care, we plan to randomize 404 patients to show a difference at a statistical power of 80%, using a two-sided alpha of 0.05. We anticipate this recruitment will be achieved by screening 2020 hospitalized HF patients for eligibility. An 8 week pilot programme of our digital health coach in 21 HF patients, age > 75 years, showed overall improvements in quality of life (13 of 21), self-care (12 of 21), and HF knowledge (13 of 21). A pilot of the use of HHU by nurses showed that it was feasible and accurate. Conclusions The Risk-HF trial will evaluate the effectiveness of a risk-guided intervention to improve HF outcomes and will evaluate the efficacy of trained HF nurses delivering a fluid management protocol that is guided by lung ultrasound with an HHU at point of care.

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Comparison of Mortality and Hospital Readmissions Among Patients Receiving Virtual Ward Transitional Care vs Usual Postdischarge Care

Chauhan

McAlister

2022

JAMA Netw Open

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IMPORTANCEVirtual wards (VWs) include patient assessment in their homes by health care personnel and offer ongoing assessment and case management via home, telephone, and/or clinic visits. The association between VWs and patient outcomes during the transition from the hospital to home are unclear; earlier reviews on this topic have often conflated telemonitoring programs with VW models. OBJECTIVE To evaluate the use of VW transition systems for community-dwelling individuals after medical discharge.

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Influence of Risk on Reduction of Readmission and Death by Disease Management Programs in Heart Failure

Cited by 27 publications

References 40 publications

Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis

Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis

Rationale and design of a risk‐guided strategy for reducing readmissions for acute decompensated heart failure: the Risk‐HF study

Comparison of Mortality and Hospital Readmissions Among Patients Receiving Virtual Ward Transitional Care vs Usual Postdischarge Care

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