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

Abstract

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...

HerzMobil, an Integrated and Collaborative Telemonitoring-Based Disease Management Program for Patients With Heart Failure: A Feasibility Study Paving the Way to Routine Care (Preprint)

“…The importance of effective communication between healthcare professionals involved with inpatient and community care (26), intense patient education to improve self-empowerment, constant medication reconciliation and therapy optimisation according to prevailing guidelines, structured outpatient follow-up for early indicators of clinical decompensation for a seamless transition from the hospital to community and the central role of specialized heart failure nurses in this complex interplay is well recognized (11,(26)(27)(28). A reliable and stable telemedical network is the facilitator for such an organizational network.…”

Transitions of Care Between Acute and Chronic Heart Failure: Critical Steps in the Design of a Multidisciplinary Care Model for the Prevention of Rehospitalization

“…Data from most studies indicate that a smooth transition in patients with HF reduces the rate of potentially avoidable readmissions and reduces the risk of adverse clinical events. 8,[10][11][12]29 …”

“…In this review, we analyze the key aspects of transitions of care in HF and the features of the programs aimed at improving its management. 6,8,[10][11][12] HEART FAILURE UNITS: COMPONENTS AND SCIENTIFIC EVIDENCE FROM THE TRADITIONAL CARE MODEL Heart failure care models inspired by the chronic care model are called disease management programs for HF, also known as heart failure programs or heart failure units (HFU). [5][6][7]13 These models aim to reduce mortality and hospital admissions in patients with HF and improve their health-related quality of life ( Figure 1).…”

Heart failure – How can we face this pandemic of twenty first century?

“…But early follow up visit within one week can lead to 8% and 29% risk reduction of all cause readmission and emergency department visits. 6 Many guideline directed medications are not prescribed or prescribed at a lower dose, which needs addition and optimization in follow up visits. Only a regular follow up visit by a dedicated group of people in a heart failure clinic can make it possible.…”