Effect of post-discharge virtual wards on improving outcomes in heart failure and non-heart failure populations: A systematic review and meta-analysis

Abstract

BackgroundUnplanned hospital admissions in high-risk patients are common and costly in an increasingly frail chronic disease population. Virtual Wards (VW) are an emerging concept to improve outcomes in these patients.PurposeTo evaluate the effect of post-discharge VWs, as an alternative to usual community based care, on hospital readmissions and mortality among heart failure and non-heart failure populations.Data sourcesOvid MEDLINE, EMBASE, PubMed, the Cochrane Database of Systematic Reviews, SCOPUS and CINAHL, from inception through to Jan 31, 2017; unpublished data, prior systematic reviews; reference lists.Study selectionRandomized trials of post-discharge VW versus community based, usual care that reported all-cause hospital readmission and mortality outcomes.Data extractionData were reviewed for inclusion and independently extracted by two reviewers. Risk of bias was assessed using the Cochrane Collaboration risk of bias tool.Data synthesisIn patients with heart failure, a post-discharge VW reduced risk of mortality (six trials, n = 1634; RR 0.59, 95% CI = 0.44–0.78). Heart failure related readmissions were reduced (RR 0.61, 95% CI = 0.49–0.76), although all-cause readmission was not. In contrast, a post-discharge VW did not reduce death or hospital readmissions for patients with undifferentiated high-risk chronic diseases (four trials, n = .3186).LimitationsHeterogeneity with respect to intervention and comparator, lacking consistent descriptions and utilization of standardized nomenclature for VW. Some trials had methodologic shortcomings and relatively small study populations.ConclusionsA post-discharge VW can provide added benefits to usual community based care to reduce all-cause mortality and heart failure-related hospital admissions among patients with heart failure. Further research is needed to evaluate the utility of VWs in other chronic disease settings.

Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis

“…Previous systematic reviews have found that interventions including patient education, home visits, self-management support, and telemonitoring have been effective in reducing hospital readmissions [ 48 – 52 ]. As such, these findings support those reported in our previous work [ 8 ] and are broadly consistent with recent systematic reviews in heart failure [ 49 – 52 ]. Thus, there appears to be strong evidence for efficacy of post-discharge interventions in heart failure patients.…”

“…A variety of post-discharge interventions have been proposed to reduce this readmission risk, ranging from minimal (i.e. follow-up telephone calls), to complex, multifaceted interventions such as “virtual wards”, which provide patients with a period of intensive multidisciplinary team management, often employing telemonitoring and nurse led case-management strategies [ 8 ]. Use of virtual wards following hospital discharge has been associated with a lower risk of readmission in certain health conditions.…”

A Cost-Minimization Analysis of Nurse-Led Virtual Case Management in Late-Stage CKD

“…In addition, drawing an analogy between telemonitoring and nurse-led case management is also reasonable, because most telemonitoring interventions apply principles or components of case management delivered remotely. 13 Our model has several important implications for the future development of home monitoring technologies in CKD. First, the economics appear to be very favorable, as even a small effect could allow for a reasonable intervention cost to generate substantial cost savings for the health care payer.…”

“…In this regard, telemonitoring and virtual ward technologies (virtual case management) have shown benefit in highrisk, specific disease states such as heart failure. 13 It is tempting to hypothesize that enhanced monitoring of patients with late-stage CKD using this technology may reduce the rate of suboptimal dialysis starts; however, the costs of any such intervention must be weighed against the potential benefits.…”

Interventional radiology training: where will technology take us?

“…Additionally, virtual ward rounds may become a routine part of NHS service for post-operative patient follow up. A recent systematic review 10 has demonstrated that patients with heart failure, have reduced rates of re-admission and mortality with post-discharge ward rounds than with standard community-based care. Hence not only may virtual clinical encounters prove educationally beneficial, but they may also be more representative of the future health service.…”