Abstract
Objectives
Heart failure (HF) heavily burdens the global health system. Transitional care interventions
attempt to streamline the hospital-to-home transition to ease the burden. This systematic
review and meta-analysis aimed to evaluate the effectiveness of transitional care
interventions on health care utilization after hospitalization for HF.
Design
Systematic review and meta-analysis including dose-response relationship.
Setting and Participants
Randomized controlled trials (RCTs) of transitional care interventions vs usual care
in older patients discharged from the hospital with HF.
Methods
Electronic databases including MEDLINE, Embase, Cochrane Library, and CINAHL, were
systematically searched from January 2009 to October 2019 to locate relevant systematic
reviews or meta-analyses. The original RCTs included in the review articles were identified,
and an additional search for recently published RCTs was performed from January 2014
to June 2020. This systematic review focused on health care utilization outcomes,
including hospital readmissions for HF or any cause, emergency department (ED) visits,
and length of hospital stay (LOS).
Results
Data were summarized from 38 RCTs covering 10,871 patients. Pooled evidence suggested
a mean 11% [risk ratio (RR) 0.89, 95% confidence interval (CI) 0.82, 0.97] and 22%
(RR 0.78, 95% CI 0.68, 0.89) risk reduction on all-cause and HF-specific readmissions,
but no significant reduction (RR 0.94, 95% CI 0.83, 1.07) on ED visits. Findings were
mixed for LOS. Subgroup analysis by different types of transitional care interventions
indicated that multidisciplinary interventions currently have the best evidence for
reducing readmissions up to 6 months post the index HF hospitalization. In addition,
we observed an inverse linear dose-response relationship between intervention intensity
(ie, frequency and duration of interventions) and complexity (ie, number of intervention
components) and the risk of HF readmissions.
Conclusions and Implications
Transitional care interventions for hospitalized patients with HF reduced all-cause
and HF-specific readmissions, but did not decrease ED visits. Multidisciplinary interventions
are highly recommended if adequate resources are available.
Keywords
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Article info
Publication history
Published online: November 03, 2020
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
