Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis

Harriette G C Van Spall; Tahseen Rahman; Oliver Mytton; Chinthanie Ramasundarahettige; Quazi Ibrahim; Conrad Kabali; Michiel Coppens; R Brian Haynes; Stuart Connolly

doi:10.1002/ejhf.765

Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis

Eur J Heart Fail. 2017 Nov;19(11):1427-1443. doi: 10.1002/ejhf.765. Epub 2017 Feb 24.

Authors

Harriette G C Van Spall^{1

2}, Tahseen Rahman², Oliver Mytton³, Chinthanie Ramasundarahettige¹, Quazi Ibrahim¹, Conrad Kabali⁴, Michiel Coppens⁵, R Brian Haynes², Stuart Connolly¹

Affiliations

¹ Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, ON, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
³ MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK.
⁴ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁵ Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.

PMID: 28233442
DOI: 10.1002/ejhf.765

Abstract

Aims: To compare the effectiveness of transitional care services in decreasing all-cause death and all-cause readmissions following hospitalization for heart failure (HF).

Methods and results: We searched PubMed, Embase, CINAHL, and Cochrane Clinical Trials Register for randomized controlled trials (RCTs) published in 2000-2015 that tested the efficacy of transitional care services in patients hospitalized for HF, provided ≥1 month of follow-up, and reported all-cause mortality or all-cause readmissions. Our network meta-analysis included 53 RCTs (12 356 patients). Among services that significantly decreased all-cause mortality compared with usual care, nurse home visits were most effective [ranking P-score 0.6794; relative risk (RR) 0.78, 95% confidence intervals (CI) 0.62-0.98], followed by disease management clinics (DMCs) (ranking P-score 0.6368; RR 0.80, 95% CI 0.67-0.97). Among services that significantly decreased all-cause readmission, nurse home visits were most effective [ranking P-score 0.8365; incident rate ratio (IRR) 0.65, 95% CI 0.49-0.86], followed by nurse case management (NCM) (ranking P-score 0.6168; IRR 0.77, 95% CI 0.63-0.95), and DMCs (ranking P-score 0.5691; IRR 0.80, 95% CI 0.66-0.97). There was no significant difference in the comparative effectiveness of services that improved each outcome. Nurse home visits had the greatest pooled cost-savings (3810 USD, 95% CI 3682-3937), followed by NCM (3435 USD, 95% CI 3224-3645), and DMCs (245 USD, 95% CI -70 to 559). Telephone, telemonitoring, pharmacist, and education interventions did not significantly improve clinical outcomes.

Conclusion: Nurse home visits and DMCs decrease all-cause mortality after hospitalization for HF. Along with NCM, they also reduce all-cause readmissions, with no significant difference in comparative effectiveness. These services reduce healthcare system costs to varying degrees.

Keywords: Comparative effectiveness; Heart failure; Transitional care.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Heart Failure / therapy*
Humans
Patient Readmission / statistics & numerical data*
Quality of Life*
Telemedicine
Transitional Care / standards*

Grants and funding

CIHR/Canada