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Transitional Care Interventions to Prevent Readmissions for Persons With Heart Failure: A Systematic Review and Meta-Analysis
Study Questions:
What are the efficacy, comparative effectiveness, and harms of transitional care interventions (aimed at facilitating the transition of care from one setting to another) to reduce readmission and mortality rates for adults hospitalized with heart failure (HF)?
Methods:
This was a meta-analysis of randomized controlled trials (RCTs) in which participants were recruited during or within 1 week of an index hospitalization for HF. Eligible trials compared a transitional care intervention with another intervention or with usual care. Eligible studies were also required to report a readmission rate, mortality rate, or composite outcome (all-cause readmission or mortality). Transitional care interventions were categorized as follows: home-visiting programs, structured telephone support (STS), telemonitoring, outpatient–clinic-based, and primarily educational.
Results:
Forty-seven RCTs were included in the meta-analysis. Compared with usual care, the following interventions reduced mortality: home-visiting programs, multi-disciplinary (MDS)-HF clinic interventions, and STS. A high-intensity home-visiting program (frequent home visits starting within 24 hours after discharge) reduced early (within 30 days) all-cause readmission and a composite endpoint of all-cause readmission or death. The following interventions reduced all-cause readmission within 3-6 months: home-visiting programs and MDS-HF clinics. Few trials reported 30-day readmission rates.
Conclusions:
There are several RCTs that compare transitional care interventions to each other or usual care. However, only home-visiting programs and MDS-HF clinics reduce all-cause readmission and mortality.
Perspective:
There is substantial interest in strategies that may effectively reduce readmissions for persons with HF. Readmissions are common and costly in this population, with nearly one in every four patients hospitalized with HF being readmitted within 30 days. Hospitals with excessive risk-standardized readmission rates are penalized by the Centers for Medicare & Medicaid Services, who have decreased reimbursements to such facilities. The current analysis is a step forward in clarifying which interventions may be most beneficial. The authors provide convincing evidence to support the benefits of home-visiting programs and MDS-HF clinics.
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