Swiss Interdisciplinary Management Programme for Heart Failure (SWIM-HF): A randomised controlled trial study of an outpatient inter-professional management programme for heart failure patients in Switzerland

Leventhal, ME; Denhaerynck, Kris; Rocca, Hans‐Peter Brunner‐La; Burnand, Bernard; A, Conca-Zeller; Bernasconi, AT; Mahrer‐Imhof, Romy; Es, Froelicher; Geest, Sabina De

doi:10.4414/smw.2011.13171

Cited by 29 publications

(72 citation statements)

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“…Sample size ranged from 42 31 to 1023 patients. 7 The majority of interventions were delivered by a specialized nurse, two interventions used a group approach, 29,39 and two interventions consisted of telephonic case management.…”

Section: Resultsmentioning

confidence: 99%

Do Self-Management Interventions Work in Patients With Heart Failure?

et al. 2016

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Background Self-management interventions are widely implemented in care for patients with heart failure (HF). Trials however show inconsistent results and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in HF patients and whether subgroups of patients respond differently. Methods and Results Systematic literature search identified randomized trials of self-management interventions. Data of twenty studies, representing 5624 patients, were included and analyzed using mixed effects models and Cox proportional-hazard models including interaction terms. Self-management interventions reduced risk of time to the combined endpoint HF-related hospitalization or all-cause death (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.71–0.89), time to HF-related hospitalization (HR, 0.80; 95%CI, 0.69–0.92), and improved 12-month HF-related quality of life (standardized mean difference 0.15; 95%CI, 0.00–0.30). Subgroup analysis revealed a protective effect of self-management on number of HF-related hospital days in patients <65 years (mean number of days 0.70 days vs. 5.35 days; interaction p=0.03). Patients without depression did not show an effect of self-management on survival (HR for all-cause mortality, 0.86; 95%CI, 0.69–1.06), while in patients with moderate/severe depression self-management reduced survival (HR, 1.39; 95%CI, 1.06–1.83, interaction p=0.01). Conclusions This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death, HF-related hospitalization alone, and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.

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Section: Resultsmentioning

confidence: 99%

Do Self-Management Interventions Work in Patients With Heart Failure?

et al. 2016

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“…Studies were carried out between 1990 and 2007 in the United States, 7,34,40–43 Netherlands, 6,33,35,44 Sweden, 29,37,46 Spain, 30,31 Canada, 47 Germany, 39 Japan, 38 Switzerland, 36 and United Kingdom. 32 Sample size ranged from 42 36 to 1023 patients. 6 Included interventions had an average intensity of 11.5 planned contacts (range 1.6–32) and duration of 8.7 months (range 0.5–18).…”

Section: Resultsmentioning

confidence: 99%

What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis

Jonkman

Westland

Ågren

et al. 2016

Journal of Cardiac Failure

142

115

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Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional-hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95%CI 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95%CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95%CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.

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“…The meta-analysis showed a significant reduc- Reasons for exclusion: duplicates; editorials; letters; comments; reviews; protocols without data, without an intervention; not on transition, transition within hospitals, to nursing home, within specialist services; from emergency to the hospital; emergency conditions; education/health promotion; speci c intervention (eg, medication prescription only) 5 trials identied through the screening of reference lists 41 included in the systematic review * References 35,37,38,41,[44][45][46][47]50,54,55,57,60,67,68,73 T …”

Section: Effect On All-cause Hospital Readmissionmentioning

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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Swiss Interdisciplinary Management Programme for Heart Failure (SWIM-HF): A randomised controlled trial study of an outpatient inter-professional management programme for heart failure patients in Switzerland

Abstract: An inter-professional disease management programme is possible in the Swiss healthcare setting but effects on outcomes need to be confirmed in larger studies.

Cited by 29 publications

References 14 publications

Do Self-Management Interventions Work in Patients With Heart Failure?

Do Self-Management Interventions Work in Patients With Heart Failure?

What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis

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

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