Certain transitional care interventions reduced readmissions after HF

Feltner C. Ann Intern Med. 2014;doi:10.7326/M14-0083.

  • June 2, 2014

The use of home-visit programs and multidisciplinary HF clinic interventions reduced all-cause readmission during a period of 3 to 6 months, according to new study results.

Moreover, structured telephone support programs reduced readmissions and mortality specific to HF, researchers wrote in Annals of Internal Medicine.

For the systematic review, researchers culled data from randomized controlled trials pertaining to adults hospitalized with HF. The selected studies compared a transitional care approach to intervention with other eligible interventions or standard care. The interventions were required to include patient or caregiver education provided before or after hospital discharge, outpatient clinic visits featuring primary care or multidisciplinary HF home visits, telemonitoring, structured telephone support case management, or provider continuity-focused interventions. All studies were required to include reports on readmissions, mortality, or all-cause readmission and mortality within 6 months of hospitalization.

The researchers identified 47 trials that met inclusion criteria. The mean age of participants was 70 years and all had moderate to severe HF.

At 30 days, a high-intensity home-visiting program was associated with reduced all-cause readmission or death; however, the researchers noted a low strength of evidence. During a period of 3 to 6 months, home-visiting programs and multidisciplinary HF clinic interventions were associated with decreased all-cause readmission, with a high strength of evidence. Further, home-visiting programs decreased HF-specific readmission and the composite endpoint of all-cause readmission or death, with a moderate strength of evidence. Use of structured telephone support strategies was linked to a decrease in HF-specific readmissions, but not a reduction in all-cause readmissions; the researchers noted this finding was based on a moderate to high strength of evidence.

In addition, the researchers observed a mortality benefit conferred by home-visiting programs, multidisciplinary HF clinics and structured telephone support interventions.

“These interventions should receive the greatest consideration by systems or providers seeking to implement transitional care interventions for persons with HF,” the researchers wrote.

The study failed to demonstrate a decrease in readmission or mortality rates with the use of telemonitoring or interventions focused primarily on education.

Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.

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