Lack of improvement of clinical outcomes by a low-cost, hospital-based heart failure management programme

Nucifora, Gaetano; Albanese, Maria; Biaggio, Paola De; Caliandro, Donato; Gregori, Darío; Goss, Paolo; Miani, Daniela; Fresco, Claudio; Rossi, Paolo; Bulfoni, A; Fioretti, P.

doi:10.2459/01.jcm.0000237910.34000.58

Cited by 58 publications

(56 citation statements)

References 41 publications

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“…The trials were conducted in a broad variety of international health care systems. Eleven were from the United States; [26][27][28][29][30][31][32][33][34][35][36] three from Hong Kong; [37][38][39] two from Australia; 40,41 and one each from Germany, 42 Spain, 43 Canada, 44 Sweden, 45 the United Kingdom, 46 Ireland, 47 Italy, 48 China, 49 Taiwan, 50 and a collaboration between Spain and Belgium. 51 The studies' sample sizes ranged from 41 to 1,001 people.…”

Section: Study Resultsmentioning

confidence: 99%

“…Second, most 27,29,30,32,[34][35][36][37][38][39]42,43,45,[47][48][49]51 of the transitional care interventions that showed an effect on intermediate-and long-term readmissions lasted longer than thirty days and measured the intermediate-and long-term rates of readmission only after thirty days. These interventions could also have had an effect within the first thirty days, but this was not measured.…”

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confidence: 99%

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Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses

Verhaegh¹,

Vroomen²,

Eslami³

et al. 2014

Health Affairs

211

220

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Transitional care interventions aim to improve care transitions from hospital to home and to reduce hospital readmissions for chronically ill patients. The objective of our study was to examine if these interventions were associated with a reduction of readmission rates in the short (30 days or less), intermediate (31-180 days), and long terms (181-365 days). We systematically reviewed twenty-six randomized controlled trials conducted in a variety of countries whose results were published in the period January 1, 1980-May 29, 2013. Our analysis showed that transitional care was effective in reducing all-cause intermediate-term and long-term readmissions. Only high-intensity interventions seemed to be effective in reducing short-term readmissions. Our findings suggest that to reduce short-term readmissions, transitional care should consist of high-intensity interventions that include care coordination by a nurse, communication between the primary care provider and the hospital, and a home visit within three days after discharge.

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Section: Study Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses

Verhaegh¹,

Vroomen²,

Eslami³

et al. 2014

Health Affairs

211

220

View full text Add to dashboard Cite

show abstract

“…Barker et al, 71 2012 X Naylor et al, 35 2004 X Kwok et al, 72 2008 X Nucifora et al, 59 2006 X X 8 RCTs combined a structured telephone call with follow-up in a clinic. 44 47,66 The vital signs transmitted daily consisted of weight, 47,66 blood pressure, pulse, and oxygen saturation.…”

Section: Moderate Intensitymentioning

confidence: 99%

“…The trials were nearly evenly split by the intensity of their TCI: 13 studied low-intensity interventions; 14, moderateintensity interventions; and 16, high-intensity interventions (Table 3). Some interventions had additional components: a nurse visiting the hospital in cases of readmission, 35,72 and patients having access to a nurse either during office hours 59,64 or at all times.…”

Section: Tci Characteristicsmentioning

confidence: 99%

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

Vedel

Khanassov

2015

The Annals of Family Medicine

100

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PURPOSE We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration. METHODSWe conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration. RESULTSWe identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87-0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51-0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious. CONCLUSIONS Clinicians and managers who implement TCIs in primary carecan incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option. INTRODUCTIONC ongestive heart failure (CHF) imposes an increasingly heavy burden on health care systems, most of which can be attributed to numerous hospital readmissions and emergency department (ED) visits. [1][2][3] Multiple exacerbations of CHF result in frequent use of acute health care services by these patients, known as revolving door users. After discharge, 25% of patients are readmitted within the first 30 days, 4,5 and 50% within the first 6 months. 6,7 This frequent use of health care services is mainly due to lack of understanding of a treatment plan, nonadherence to medical therapy, unawareness of CHF symptom exacerbation, and irregular follow-up. [8][9][10][11][12] Lack of coordination and communication between hospitalists and primary care physicians (PCPs) has been documented. 13,14 PCPs too often do not receive discharge summaries, 15 and when they do receive them, the summaries often lack appropriate documentation of medication indication and advice for follow-up. It is therefore difficult for PCPs to plan an appropriate follow-up after hospital discharge. 16To address these issues, transitional care interventions (TCIs) have been implemented with a common objective of reducing the rate of hos- 563pital readmis...

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“…15,[17][18][19][20] Evaluations of DMPs for HF are difficult because, despite efforts by the AHA to promote a standardized taxonomy, a great deal of heterogeneity still exists. For example, they differed in follow-up duration, age of patients, severity of the disease, drug therapy, and intervention model.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia

Hebert

Quevedo

Gogichaishvili

et al. 2011

Circ: Heart Failure

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Background-Little is known about the importation of a heart failure disease management program (HFDMP) into lowand middle-income countries. We examined the feasibility of importing a HFDMP into the country of Georgia, located in the Caucuses. Methods and Results-Patients with ejection fraction Յ40% were enrolled into a prospective, observational study consisting of a new HFDMP staffed by local cardiologists. Medications, emergency department use, hospital admissions, and mortality were assessed by interviews with patients or their families. Screening resulted in 400 patients who were followed for 10.2Ϯ3.5 months. ␤-Blocker prescriptions increased from 7.4 -80.7% (PϽ0.001), angiotensinconverting enzyme inhibitor prescriptions increased from 18.4 -92.6% (PϽ0.001), and mean systolic blood pressure declined from 145 to 114 mm Hg (PϽ0.001). Patients visiting the emergency department and hospitalizations were lowered by 40.7% and 52.5%, respectively, but were also influenced by the outbreak of war, during which 17.5% (nϭ70) of patients received follow-up in refugee tents. All-cause mortality extended to 7% of patients, with 12 of 28 deaths caused by war-related events. Conclusions-Importation of a Western HFDMP was demonstrated to be feasible, with a 5-fold increase in the use of recommended therapies, reduction of blood pressure, decrease of emergency department visits, and hospitalizations for heart failure. These measures could result in substantial cost savings in resource-limited settings, but assessment is complicated in unstable areas. Translating effective interventions to low-and middle-income countries requires sensitivity to regional cultures and flexibility to adapt both clinical goals and strategies to unexpected conditions. (Circ Heart Fail. 2011;4:763-769.)

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Lack of improvement of clinical outcomes by a low-cost, hospital-based heart failure management programme

Abstract: The present low-cost HF management programme reduced unplanned outpatient visits but proved ineffective in reducing subsequent readmissions and in improving clinical status. More intense follow-up monitoring and more resources are needed to achieve better results.

Cited by 58 publications

References 41 publications

Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses

Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

Feasibility of a Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia

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