Optimal effectiveness of heart failure management — an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

Abstract

Heart failure (HF) is a major health concern, which accounts for 1–2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.

Digital Health Technologies for Post-Discharge Care after Heart Failure Hospitalisation to Relieve Symptoms and Improve Clinical Outcomes

“…The meta-analysis by Zhu et al [ 21 ] presented consistent results, reporting the beneficial effects of telemedicine strategies on all-cause hospitalisation, cardiac hospitalisation, all-cause mortality, and cardiac mortality. The positive effect of telemonitoring was also confirmed by Hafkamp et al [ 22 ], who found a lower risk of HF-related hospitalisations (HR = 0.86, 95% CI: 0.81–0.92, p < 0.001). Drews et al [ 5 ] summarised only studies in patients with HF decompensation within the previous month with intervention based on using telemonitoring, defined as the regular transmission of at least one physical variable at least once weekly.…”

Integration of patient experience factors improves readmission prediction

“…[ 13 ] Further, interventions attempting to attenuate readmission have been studied, including the use of community health workers [ 14 , 15 ] and disease-specific interventions. [ 16 ] However, patient experience factors remain under-appreciated.…”

Evaluating Guideline-Directed Medical Therapy (GDMT) in Yemeni’s Patients with Heart Failure

“…It is the major cause of hospitalization in older people. Hospitalization due to HF increases healthcare resource utilization, as it accounts for more than half of total healthcare costs (1) .…”

“…Identifying the specific cause of HF is crucial, due to the fact situations that reason HF might also require disorder specific treatment plans. The major goals of treatment in heart failure are (1) to improve prognosis and decrease mortality and (2)…”