Harriette G.C. Van Spall, MD, MPH, FRCPC
What is the effectiveness of clinical service interventions in patients previously hospitalized for heart failure (HF)?
Included studies had ≥ 6 months of follow-up and compared clinical service interventions with usual care in patients ≥ 18 years of age who had ≥ 1 previous secondary care admission with HF. Clinical service interventions had to be directed at patients with HF and included case management (intense postdischarge monitoring, usually by specialist nurses), outpatient HF clinic follow-up by specialists, and multidisciplinary interventions with holistic approaches. Exclusion criteria included HF due to congenital or valvular heart disease; primarily educational or unstructured telephone or videoconferencing interventions; or interventions focused only on exercise, telemedicine, or cardiac rehabilitation. Outcomes included mortality and secondary care readmissions.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, and AMED (to Jan 2009); Cochrane Central Register of Controlled Trials and DARE (Cochrane Library, Issue 1, 2009); a previous version of this review; and reference lists were searched for randomized controlled trials (RCTs). 25 RCTs (n = 5942, mean or median age range 56 to about 80 y, 39% to 84% men, follow-up range 6 mo to 2 y) met inclusion criteria: 16 evaluated case management, 5 evaluated specialist HF clinics, 2 evaluated multidisciplinary interventions, 1 evaluated both case management and specialist HF clinics, and 1 could not be categorized. Patient and intervention characteristics varied across studies. 10 studies reported adequate allocation concealment, 12 used blinding for outcome assessors, and 16 reported intention-to-treat analysis.
The main results are in the Table.
In patients with previous heart failure admissions, clinical service interventions reduce mortality and HF readmissions more than usual care. Results were most robust for case management.
Clinical service interventions vs usual care in patients with previous HF hospitalizations*
†HF = heart failure; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, and CI calculated from risk ratios and risk differences in statistical data file of article using a random-effects model.
†Calculated from risk ratio and control event rate.
Harriette G.C. Van Spall. Review: Case management reduces mortality and HF readmissions in patients with HF. Ann Intern Med. 2013;158:JC11. doi: 10.7326/0003-4819-158-2-201301150-02011
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Published: Ann Intern Med. 2013;158(2):JC11.
Cardiology, Heart Failure, Hospital Medicine.
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