Non-Pharmacological Interventions for Post-Discharge Care in Heart Failure. Technology Assessment Report

摘要

This report identified 49 randomized controlled trials that evaluated interventions utilizing various combinations of individual components initiated in three different settings. We included studies published since 1990 the time point associated with rapid advances in the medical management of HF, and changing health needs of the patients and changes in the practice patterns. The majority of the included studies reported readmissions as the primary outcome of interest. A few studies also evaluated combined endpoint of readmissions or death as the primary outcome of interest. In general, studies were not adequately powered to evaluate the clinical outcome of mortality. We performed meta-analysis and subgroup analyses to address the key question of the effectiveness of interventions of post-discharge support to prevent readmissions. Our report used lax inclusion criteria, thereby reviewing a large body of literature. We identified those interventions that utilized increased clinic visits, home visits, and multidisciplinary care to reduce the risk of readmissions in the intervention group compared with the usual care group. Often these interventions utilized a combination of secondary components, with telephone followup being the most common across the studies; however, when telephone followup was utilized alone, it did not demonstrate a significant difference in all cause readmissions compared with usual care.