Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis

Pandor, Abdullah; Gomersall, Tim; Stevens, John; Wang, Jenny; Mohammad, Atif; Bakhai, Ameet; Cleland, John G.F.; Cowie, Martin R.; Wong, Ruth

doi:10.1136/heartjnl-2013-303811

Cited by 123 publications

(136 citation statements)

References 46 publications

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“…2,17,18,21 To date, a few systematic reviews have been published on TCIs. [22][23][24] It has been shown that the interventions decrease hospital admissions after 12 months of follow-up.22 These reviews, however, were unable to determine the most efficacious TCI.22,24 They did not include all types of TCIs 22,23 ; furthermore, a substantial number of RCTs on these interventions have been published since the publication of the reviews (26 since that by Phillips et al 24 ). We therefore conducted a systematic review and meta-analysis to determine the impact of TCIs on the rate of all-cause readmission and ED visits by patients with CHF, and to identify the most effective TCIs and their optimal duration.…”

mentioning

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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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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mentioning

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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“…U meta-analizi istraaeivanja ukljuËujuÊi viπe od 6.000 bolesnika, Pandor i sur. 35 su utvrdili da je telemonitoring nakon prijma u bolnicu bolesnika sa ZS bio povezan s boljim preaeivljavanjem, posebice tamo gdje je uobiËajena skrb bila manje dobra.…”

Section: Terapija Ure-ajima I Pra∆enje Telemonitoriranjeunclassified

“…It might be that targeted intensive monitoring during periods of high risk, such as immediately after hospital discharge, makes the best use of remote monitoring. In a meta-analysis of trials involving over 6,000 patients, Pandor et al 35 found that remote monitoring following an admission with heart failure was associated with improved survival, particularly where usual care was less good.…”

Section: Remote Monitoringmentioning

confidence: 99%

Almanac 2013: heart failure

Clark

2013

Cardiol Croat.

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“…In a meta-analysis of trials involving over 6000 patients, Pandor et al (35) found that remote monitoring following an admission with heart failure was associated with improved survival, particularly where usual care was less good.…”

Section: Device Therapy and Monitoringmentioning

confidence: 99%

Almanac 2013: heart failure

Clark¹

2014

Anadolu Kardiyol Derg

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Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis

Abstract: STS HH and TM with medical support provided during office hours showed beneficial trends, particularly in reducing all-cause mortality for recently discharged patients with heart failure. Where 'usual' care is less good, the impact of RM is likely to be greater.

Cited by 123 publications

References 46 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

Almanac 2013: heart failure

Almanac 2013: heart failure

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