What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review

Abstract

BackgroundHospital admissions for heart failure are predicted to rise substantially over the next decade placing increasing pressure on the health care system. There is an urgent need to redesign systems of care for heart failure to improve evidence-based practice and create seamless transitions through the continuum of care. The aim of the review was to examine systems of care for heart failure that reduce hospital readmissions and/or mortality.MethodElectronic databases searched were: Ovid MEDLINE, EMBASE, CINAHL, grey literature, reviewed bibliographies and Cochrane Central Register of Controlled Trials for randomised controlled trials, non-randomised trials and cohort studies from 1st January 2008 to 4th August 2015. Inclusion criteria for studies were: English language, randomised controlled trials, non-randomised trials and cohort studies of systems of care for patients diagnosed with heart failure and aimed at reducing hospital readmissions and/or mortality.Three reviewer authors independently assessed articles for eligibility based on title and abstract and then full-text. Quality of evidence was assessed using Newcastle-Ottawa Scale for non-randomised trials and GRADE rating tool for randomised controlled trials.ResultsWe included 29 articles reporting on systems of care in the workforce, primary care, in-hospital, transitional care, outpatients and telemonitoring. Several studies found that access to a specialist heart failure team/service reduced hospital readmissions and mortality. In primary care, a collaborative model of care where the primary physician shared the care with a cardiologist, improved patient outcomes compared to a primary physician only. During hospitalisation, quality improvement programs improved the quality of inpatient care resulting in reduced hospital readmissions and mortality. In the transitional care phase, heart failure programs, nurse-led clinics, and early outpatient follow-up reduced hospital readmissions. There was a lack of evidence as to the efficacy of telemonitoring with many studies finding conflicting evidence.ConclusionRedesigning systems of care aimed at improving the translation of evidence into clinical practice and transitional care can potentially improve patient outcomes in a cohort of patients known for high readmission rates and mortality.

Cardio‐geriatric model of care in acute heart failure: initial experience of a multidisciplinary approach in complex elderly patients

“…Incident hospital readmission is commonly used as an index of the quality of care provision, where the care provided by a healthcare organisation is considered responsible for the patient outcomes in the post‐discharge period . In addition to the documented benefit of evidence‐based management of chronic HF, various overlapping care strategies employed during the phase of transition from hospital to community may be associated with reduced readmissions, as we identified in a recent systematic review: (i) the presence of a dedicated HF medical and nursing team, (ii) inpatient and outpatient medical care involving a cardiologist or HF specialist, (iii) early review in a dedicated HF clinic and (iv) the presence of a quality improvement programme specific to HF care . We reasoned that geriatric speciality input in the acute period would further address the care needs of patients hospitalised with decompensated HF and proposed a system‐wide practice change targeting those 65 years of age and over.…”

How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association

“…34,35 Collaborative models of care where the primary care physician may share the care with a cardiologist have been shown to improve patient outcomes compared with a primary physician only. 36 Technology may play a leading role in this regard, as telemedicine platforms have been designed to link teams of experts within an academic hub with primary care clinicians to improve care provision and enhance primary physicians' learning by providing mentoring and feedback from specialists. 37 Therefore, designing and establishing highly collaborative HF networks that co-ordinate all groups involved in HF care provision at various levels may improve HF patient outcomes and ensure that limited resources are effectively deployed.…”

Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self‐care: impact on outcomes

“…Most of these initiatives, to a greater or lesser degree, educate and motivate patients to learn about the disease and collaborate in their own care, but their results have been inconsistent. In addition, most studies testing these programmes included relatively young patients, with a mean age < 70 years, clearly lower than the average age of patients hospitalized for HF …”

“…In addition, most studies testing these programmes included relatively young patients, with a mean age < 70 years, clearly lower than the average age of patients hospitalized for HF. 13,15 In spite of differences in content, duration and personnel involved in care, a number of self-management interventions has demonstrated some benefits in reducing HF-related hospitalization and death. 16 The mechanisms by which self-care and disease management programmes are effective, and the common components of the most successful interventions have also been addressed.…”