A multicenter disease management program for hospitalized patients with heart failure

Tsuyuki, Ross T.; Fradette, Miriam; Johnson, Jeffrey; Bungard, Tammy J.; Eurich, Dean T.; Ashton, Thomas; Gordon, Wendy; Ikuta, Roland M.; Kornder, Jan M.; Mackay, Elizabeth; Manyari, Dante E.; O’Reilly, Ken; Semchuk, William

doi:10.1016/j.cardfail.2004.02.005

Cited by 119 publications

(179 citation statements)

References 28 publications

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“…The meta-analysis showed a significant reduc- Riegel et al, 37 2006 X 11 RCTs had a prearranged telephone followup. [37][38][39][40][41][42][43][44]53,56,62 Patients received 3 to 16 telephone calls (over a 2-to 12-month period). Domingues et al, 56 2011 X DeBusk et al, 38 2004 X Laramee et al, 39 2003 X Wakefield et al, 40 2008 X Dunagan et al, 41 2005 X Rainville et al, 42 1999 X Tsuyuki et al, 53 2004 X Barth et al, 43 2001 X Lopez Cabezas et al, 62 2006 X Chaudhry et al, 44 2010 X Doughty et al, 70 2002 X In 2 RCTs, follow-up was provided in an outpatient clinic by the family physician or a cardiologist or multidisciplinary team.…”

Section: Effect On All-cause Hospital Readmissionmentioning

confidence: 99%

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Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

Vedel

Khanassov

2015

The Annals of Family Medicine

104

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PURPOSE We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration. METHODSWe conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration. RESULTSWe identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87-0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51-0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious. CONCLUSIONS Clinicians and managers who implement TCIs in primary carecan incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option. INTRODUCTIONC ongestive heart failure (CHF) imposes an increasingly heavy burden on health care systems, most of which can be attributed to numerous hospital readmissions and emergency department (ED) visits. [1][2][3] Multiple exacerbations of CHF result in frequent use of acute health care services by these patients, known as revolving door users. After discharge, 25% of patients are readmitted within the first 30 days, 4,5 and 50% within the first 6 months. 6,7 This frequent use of health care services is mainly due to lack of understanding of a treatment plan, nonadherence to medical therapy, unawareness of CHF symptom exacerbation, and irregular follow-up. [8][9][10][11][12] Lack of coordination and communication between hospitalists and primary care physicians (PCPs) has been documented. 13,14 PCPs too often do not receive discharge summaries, 15 and when they do receive them, the summaries often lack appropriate documentation of medication indication and advice for follow-up. It is therefore difficult for PCPs to plan an appropriate follow-up after hospital discharge. 16To address these issues, transitional care interventions (TCIs) have been implemented with a common objective of reducing the rate of hos- 563pital readmis...

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Section: Effect On All-cause Hospital Readmissionmentioning

confidence: 99%

“…Five trials provided data on all-cause ED visits 43,[53][54][55][56] ; a forest plot of their results is shown in Figure 3. The meta-analysis showed a significant 29% reduction in the risk of ED visits for TCI as compared with usual care (RR = 0.71; 95% CI, 0.52-0.98).…”

Section: Effect On All-cause Ed Visitsmentioning

confidence: 99%

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

Vedel

Khanassov

2015

The Annals of Family Medicine

104

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“…36,37,[39][40][41] Studies Assessing Medication Adherence A summary of studies evaluating pharmacist interventions on medication adherence is presented in Table 3. [36][37][38][39][40][41][42][43][44] One of the earliest randomized controlled trials that assessed the effect of intensive pharmacist counseling randomized 100 elderly patients with stable HF in the United Kingdom to a 3-month pharmacist counseling intervention versus standard care. 40 Medication adherence, per pill count, was 93% for the intervention group and 51% for the control group post-intervention (P < 0.001).…”

Section: Pharmacist Interventions To Improve Adherencementioning

confidence: 99%

“…43,44 In a multicenter study, Tsuyuki et al (2004) randomized 276 patients discharged with HF to an intervention consisting of patient education, adherence aids, written materials, and medication schedule, conducted by a hospital nurse or pharmacist versus usual care in Canada. 43 Patients in the intervention group were contacted at 2 weeks and 4 weeks, then monthly thereafter. The control group was contacted monthly only to capture clinical events.…”

Section: Studies Not Assessing Medication Adherencementioning

confidence: 99%

The Pharmacist Role in Predicting and Improving Medication Adherence in Heart Failure Patients

Davis

Packard²,

Jackevicius

2014

JMCP

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“…Drugs to be used with caution or avoided Patients with heart failure are clinically fragile (42,43) and are especially susceptible to drugs that worsen heart failure symptoms (either by reducing contractility or by causing fluid retention). Drug-induced heart failure has been recently reviewed (44,45).…”

Section: General Principlesmentioning

confidence: 99%

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

Arnold¹,

Liu²,

Demers³

et al. 2006

Canadian Journal of Cardiology

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363

256

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A multicenter disease management program for hospitalized patients with heart failure

Cited by 119 publications

References 28 publications

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

The Pharmacist Role in Predicting and Improving Medication Adherence in Heart Failure Patients

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

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