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Review: Case management reduces mortality and HF readmissions in patients with HF.
MedLine Citation:
PMID:  23318333     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
QUESTION What is the effectiveness of clinical service interventions in patients previously hospitalized for heart failure (HF)? REVIEW SCOPE Included studies had ≥ 6 months of follow-up and compared clinical service interventions with usual care in patients ≥ 18 years of age who had ≥ 1 previous secondary care admission with HF. Clinical service interventions had to be directed at patients with HF and included case management (intense postdischarge monitoring, usually by specialist nurses), outpatient HF clinic follow-up by specialists, and multidisciplinary interventions with holistic approaches. Exclusion criteria included HF due to congenital or valvular heart disease; primarily educational or unstructured telephone or videoconferencing interventions; or interventions focused only on exercise, telemedicine, or cardiac rehabilitation. Outcomes included mortality and secondary care readmissions. REVIEW METHODS MEDLINE, EMBASE/Excerpta Medica, CINAHL, and AMED (to Jan 2009); Cochrane Central Register of Controlled Trials and DARE (Cochrane Library, Issue 1, 2009); a previous version of this review; and reference lists were searched for randomized controlled trials (RCTs). 25 RCTs (n = 5942, mean or median age range 56 to about 80 y, 39% to 84% men, follow-up range 6 mo to 2 y) met inclusion criteria: 16 evaluated case management, 5 evaluated specialist HF clinics, 2 evaluated multidisciplinary interventions, 1 evaluated both case management and specialist HF clinics, and 1 could not be categorized. Patient and intervention characteristics varied across studies. 10 studies reported adequate allocation concealment, 12 used blinding for outcome assessors, and 16 reported intention-to-treat analysis. MAIN RESULTS The main results are in the Table. CONCLUSIONS In patients with previous heart failure admissions, clinical service interventions reduce mortality and HF readmissions more than usual care. Results were most robust for case management.Clinical service interventions vs usual care in patients with previous HF hospitalizations*InterventionsOutcomesNumber of trials (n)Weighted event ratesRRR (95% CI)NNT (CI)All typesAll-cause mortality24 (5671)17% vs 22%21% (7 to 32)20 (13 to 50)HF readmission12 (3135)25% vs 37%30% (17 to 41)9 (6 to 17)Case managementMortality at ≅ 12 mo11 (2801)18% vs 25%27% (7 to 43)15 (9 to 50)HF mortality3 (1423)14% vs 16%10% (-15 to 30)Not significantHF readmission at ≅ 12 mo7 (1726)21% vs 37%38% (16 to 54)7 (4 to 17)MultidisciplinaryAll-cause mortality2 (403)19% vs 25%21% (-12 to 45)Not significantHF readmission2 (403)20% vs 34%41% (19 to 57)8 (6 to 16)†Specialist clinicAll-cause mortality6 (1486)22% vs 27%19% (-8 to 40)Not significantRRI (CI)NNHHF readmission2 (869)26% vs 26%1% (-19 to 27)Not significant†HF = heart failure; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, and CI calculated from risk ratios and risk differences in statistical data file of article using a random-effects model.†Calculated from risk ratio and control event rate.
Authors:
Harriette G C Van Spall
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  JC11     Citation Subset:  AIM; IM    
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