Heart failure disease management with specialist nurse-led clinics resulted in an overall relative risk for readmission of 0.91 (95% CI 0.72-1.16) compared to usual care.
Meta-Analysis (n=949)
Does heart failure disease management incorporating specialist nurse-led HF clinics reduce readmission in patients with heart failure?
Specialist nurse-led heart failure clinics show promise, particularly when incorporating hospital discharge planning and immediate post-discharge follow-up.
Effect estimate: RR 0.91 (95% CI 0.72-1.16)
OBJECTIVES: To determine whether a hierarchy of effectiveness exists with respect to complexity of published protocols of heart failure (HF) disease management (DM) incorporating specialist nurse-led HF clinics. DATA SOURCES AND STUDY SELECTION: We searched MEDLINE (1966-November 2004), the Cochrane Library, article bibliographies, and contacted experts. Inclusion criteria were random allocation of at least 100 patients, specialist HF nurses, HF clinics, and readmission as an outcome measure. DATA EXTRACTION: Paired reviewers conducted quality assessment, deconstructed and categorized protocols by complexity, and extracted results for readmission, mortality, the combined endpoint of mortality and hospitalization, HF readmission, and hospital days utilized. DATA SYNTHESIS: Six trials were selected (N=949, mean age 73 years range 62-79, men 58%, LVEF 34% 27-41, and average follow-up of 8.5 months 3-12). Compared with usual care, the overall relative risk 95% confidence interval for readmission with this strategy was 0.91 0.72, 1.16, mortality was 0.80 0.57, 1.06, and the combined endpoint of mortality and hospitalization was 0.88 0.74, 1.04. We observed better outcomes for programs with versus programs without hospital discharge planning and immediate post-discharge follow-up; readmission 0.30 0.04, 2.60 vs. 1.00 0.86, 1.17, mortality 0.96 0.63, 1.47 vs. 0.75 0.55, 1.03, the combined endpoint of mortality and hospitalization 0.61 0.18, 2.02 vs. 0.91 0.80, 1.03, HF readmission 0.09 0.10, 0.65 vs. 0.65 0.43, 1.00, and hospitalized days utilized per patient -0.26 -0.49,-0.02 vs. 0.09 -1.17, 1.34. CONCLUSIONS: HF DM with specialist nurse-led HF clinics is a promising strategy or effective alternative whose benefit may be optimized by programs with a homogeneous structure and components that are delivered with consistency.
Phillips et al. (Thu,) conducted a meta-analysis in Heart failure (n=949). Heart failure disease management incorporating specialist nurse-led HF clinics vs. Usual care was evaluated on Readmission (RR 0.91, 95% CI 0.72-1.16). Heart failure disease management with specialist nurse-led clinics resulted in an overall relative risk for readmission of 0.91 (95% CI 0.72-1.16) compared to usual care.