Some transitional care interventions more effective than others for reducing readmissions and mortality following hospitalizations for heart failure

Home-visit programs and multidisciplinary clinics reduced all-cause readmission and mortality for up to 6 months following hospitalizations for heart failure, a meta-analysis found.

Researchers conducted a meta-analysis of 47 trials published between January 1990 and October 2013 that reported a readmission or mortality rate within 6 months of a hospitalization. Studies included adults recruited during or within 1 week of an index hospitalization for heart failure. They compared a transitional care intervention with another eligible intervention or with usual care. Interventions included education of patient or caregiver before or after discharge, planned or scheduled outpatient clinic visits (primary care or multidisciplinary heart failure [MDS-HF] clinic), home visits, telemonitoring, structured telephone support, transition coach or case management, or interventions to increase clinician continuity.

Results were published online by Annals of Internal Medicine on May 27.

Both home visits and multidisciplinary clinic interventions reduced all-cause readmissions over 3 to 6 months (high strength of evidence; number needed to treat [NNT], 7 to 9). Structured telephone support and telemonitoring interventions were not effective in reducing readmissions (moderate strength of evidence for both). Similarly, nurse-led clinic interventions were not effective (low strength of evidence), and there was not enough evidence to determine whether primarily educational interventions were effective for this outcome.

Home visits (moderate strength of evidence; NNT, 7) and telephone interventions (high strength of evidence; NNT, 14) reduced the risk for heart failure-specific readmissions. Telemonitoring did not (moderate strength of evidence). There was only 1 trial, with unknown consistency, for multidisciplinary clinic interventions, nurse-led interventions, or primarily educational interventions, which was not enough evidence to determine whether they reduced readmissions for heart failure.

Mortality rates stratified by intervention category and outcome timing showed that some of the interventions reduced mortality compared with usual care (moderate strength of evidence): home-visiting programs (NNT, 33), multidisciplinary clinic interventions (NNT, 18), and telephone support (NNT, 27). Telemonitoring, nurse-led clinics, and primarily educational interventions did not reduce mortality (low strength of evidence). There was not enough evidence to determine whether primary care interventions and cognitive training programs affected mortality.

“Our findings provide guidance to quality improvement efforts aimed at reducing readmission and mortality rates for persons with HF [heart failure],” the authors noted. “Home-visiting programs and MDS-HF clinic interventions currently have the best evidence for reducing all-cause readmissions and mortality up to 6 months after an index hospitalization for persons with HF.”