A transitional care model reduced all-cause emergency department visits among females (HR 0.66; 95% CI 0.51-0.87) but not males following hospitalization for heart failure.
RCT (n=2,494)
stepped-wedge cluster
Sí
Does a transitional care model reduce composite all-cause readmission, emergency department visits, or death in adults hospitalized for heart failure?
A transitional care model following heart failure hospitalization significantly reduced all-cause emergency department visits in females but not in males.
Estimación del efecto: HR 0.83 (95% CI 0.69-1.01)
Tasa de eventos absoluta: 59.9% vs 64.8%
valor p: p=0.06
Background: Transitional care may have different effects in males and females hospitalized for heart failure. We assessed the sex-specific effects of a transitional care model on clinical outcomes following hospitalization for heart failure. Methods: In this stepped-wedge cluster randomized trial of adults hospitalized for heart failure in Ontario, Canada, 10 hospitals were randomized to a group of transitional care services or usual care. Outcomes in this exploratory analysis were composite all-cause readmission, emergency department visit, or death at 6 months; and composite all-cause readmission or emergency department visit at 6 months. Models were adjusted for stepped-wedge design and patient age. Results: Among 2494 adults, mean (SD) age was 77.7 (12.1) years, and 1258 (50.4%) were female. The first composite outcome occurred in 371 (66.3%) versus 433 (64.1%) males (hazard ratio HR, 1.04 95% CI, 0.86–1.26; P =0.67) and in 326 (59.9%) versus 463 (64.8%) females (HR, 0.83 95% CI, 0.69–1.01; P =0.06) in the intervention and usual care groups, respectively ( P =0.012 for sex interaction). The second composite outcome occurred in 357 (63.8%) versus 417 (61.7%) males (HR, 1.03 95% CI, 0.85–1.24; P =0.76) and 314 (57.7%) versus 450 (63.0%) females (HR, 0.81 95% CI, 0.67–0.99; P =0.037) in the intervention and usual care groups, respectively ( P =0.024 for sex interaction). The sex differences were driven by a reduction in all-cause emergency department visits among females (HR, 0.66 95% CI, 0.51–0.87; P =0.003), but not males (HR, 1.10 95% CI, 0.85–1.43; P =0.46), receiving the intervention ( P <0.001 for sex interaction). Conclusions: A transitional care model offered a reduction in all-cause emergency department visits among females but not males following hospitalization for heart failure. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02112227.
Spall et al. (Fri,) conducted a rct in heart failure (n=2,494). transitional care services vs. usual care was evaluated on composite all-cause readmission, emergency department visit, or death at 6 months (females) (HR 0.83, 95% CI 0.69-1.01, p=0.06). A transitional care model reduced all-cause emergency department visits among females (HR 0.66; 95% CI 0.51-0.87) but not males following hospitalization for heart failure.