Home visits delivered by and clinics staffed by multidisciplinary teams reduce hospital readmission and deaths among patients with heart failure

Feltner C, Jones CD, Cené CW, et al.  Transitional care interventions to prevent readmissions for people with heart failure: A systematic review and meta-analysis Annals of Internal Medicine. 2014; 160(11):774-784.

Review question

What strategies are effective at reducing readmissions to hospitals for people with heart failure?

Background

Heart failure is a leading driver of healthcare costs with many patients readmitted to hospitals within 30 days after their initial hospitalization.

Strategies designed to prevent readmissions aim to reduce poor outcomes by focusing on patient and caregiver education, medication review and increased coordination among healthcare professionals.  

How the review was done

Several electronic databases were searched for documents published between July 1, 2007 and October 2013, and clinical trial registries were accessed to find studies published prior to July 1 2007.

Studies were included if they met specific quality standards, focused on adult patients with heart failure, and compared standard care to strategies aimed to reduce hospital readmissions.

Of the 2,419 studies identified in searches, 47 were included and analyzed in the review.

What the researchers found

The review found that home-visiting programs and heart failure clinics provided by multidisciplinary teams reduced readmissions and patient deaths at six months after heart failure.

There are still gaps in evidence to determine whether these strategies reduce 30-day readmission rates.

It isn’t clear whether home-visiting programs are more or less effective compared to multidisciplinary clinics given that no head-to-head comparisons have been done.

Many patients with heart failure do not have access to specialty services, but it was found that many (particularly  those living in rural areas) preferred primary care clinics, meaning more work should be done to determine if strategies in primary care settings are effective at reducing readmissions.

Conclusion

Patients with heart failure that receive home-visits and/or attend clinics for those with heart failure delivered by multidisciplinary teams have lower rates of hospital readmission and are less likely to die compared to patients receiving usual care.