Comparative effectiveness of transitional care interventions for hospital-to-home transition in heart failure: an updated systematic review and network meta-analysis

Background The transition from hospital to home represents a high-risk "vulnerable period" for patients with heart failure (HF). While numerous transitional care interventions (TCIs) have been developed, their relative efficacy and optimal hierarchy remain uncertain in the context of modern clinical practice. Objective To evaluate and rank the effectiveness of different TCIs in reducing readmissions and mortality and improving quality of life (QoL) in hospitalized HF patients. Methods We updated the 2014 Feltner review by integrating its previously included RCTs with a new systematic search of PubMed, Embase, and Cochrane CENTRAL (November 2013 to January 2025). Interventions were categorized into eight nodes: Home Visiting (HV), Multidisciplinary Clinics (MDC), Telemonitoring (TM), Structured Telephone Support (STS), Pharmacy-led Care (PHARM), Physical Rehabilitation (REHAB), Education (EDU), and Usual Care (UC). A frequentist network meta-analysis was performed using a random-effects model, and interventions were ranked using P-scores. Results Nineteen trials involving 11,452 patients were included. For all-cause readmission, HV was the only intervention significantly superior to UC (RR 0.67, 95% CI 0.52–0.86) and was ranked highest (P-score = 0.902). For all-cause mortality, HV (P-score = 0.872) and MDC (P-score = 0.556) showed the highest probability of being best. Notably, MDC ranked first for reducing HF-specific readmission (P-score = 0.890), while REHAB and MDC were the most effective for enhancing Quality of Life (SMD ranking). TM showed moderate efficacy in mortality reduction but ranked poorly for readmission prevention. Conclusion Nurse-led Home Visiting emerged as the highest-ranked strategy for reducing overall hospital utilization and mortality. Multidisciplinary clinics are superior for disease-specific stabilization, while physical rehabilitation is essential for improving functional well-being. A bundled approach integrating these elements should be prioritized in clinical pathways to optimize heart failure care transitions. Trial registration PROSPERO registration number: CRD420261299376.