Does case management for patients with heart failure based in the community reduce unplanned hospital admissions?:A systematic review and meta-analysis

摘要

The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).  CM initiated either whilst as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.  Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.CM based on nurse co-ordinated multi-component care which is applicable to the primary care based health systems.Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary health care resources. Twenty-two studies were included: 17 RCTs and five NRCTs. Seventeen studies described hospital-initiated CM (n=4794) and five described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 [95%CI 0.60, 0.92] p=0.008) and LOS (mean difference -1.28 days [95%CI -2.04,-0.52] p=0.001) in favour of CM compared to usual care. Nine trials described cost data of which six reported no difference between CM and usual care. There were four studies of community-initiated CM versus usual care (2RCTs and 2NRCTs) with only the 2 NRCTs showing a reduction in admissions. Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. Nine trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission. No- High quality systematic review- Interventions examine nurse-led multicomponent care of heart failure patients- Focus on use of resources specific to heart failure- Community-initiated case management trials were limited in quantity and were mostly of low quality.- Lack of cost data in most trials