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Bamforth, Ryan J.; Chhibba, Ruchi; Ferguson, Thomas W.; Sabourin, Jenna; Pieroni, Domenic; Askin, Nicole; Tangri, Navdeep; Komenda, Paul; Rigatto, Claudio

Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis

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  • Medientyp: E-Artikel
  • Titel: Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis
  • Beteiligte: Bamforth, Ryan J.; Chhibba, Ruchi; Ferguson, Thomas W.; Sabourin, Jenna; Pieroni, Domenic; Askin, Nicole; Tangri, Navdeep; Komenda, Paul; Rigatto, Claudio
  • Erschienen: Public Library of Science (PLoS), 2021
  • Erschienen in: PLOS ONE
  • Sprache: Englisch
  • DOI: 10.1371/journal.pone.0249542
  • ISSN: 1932-6203
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec id="sec001"> <jats:title>Background</jats:title> <jats:p>Readmission following hospital discharge is common and is a major financial burden on healthcare systems.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Objectives</jats:title> <jats:p>Our objectives were to 1) identify studies describing post-discharge interventions and their efficacy with respect to reducing risk of mortality and rate of hospital readmission; and 2) identify intervention characteristics associated with efficacy.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Methods</jats:title> <jats:p>A systematic review of the literature was performed. We searched MEDLINE, PubMed, Cochrane, EMBASE and CINAHL. Our selection criteria included randomized controlled trials comparing post-discharge interventions with usual care on rates of hospital readmission and mortality in high-risk chronic disease patient populations. We used random effects meta-analyses to estimate pooled risk ratios for all-cause and cause-specific mortality as well as all-cause and cause-specific hospitalization.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Results</jats:title> <jats:p>We included 31 randomized controlled trials encompassing 9654 patients (24 studies in CHF, 4 in COPD, 1 in both CHF and COPD, 1 in CKD and 1 in an undifferentiated population). Meta-analysis showed post-discharge interventions reduced cause-specific (RR = 0.71, 95% CI = 0.63–0.80) and all cause (RR = 0.90, 95% CI = 0.81–0.99) hospitalization, all-cause (RR = 0.73, 95% CI = 0.65–0.83) and cause-specific mortality (RR = 0.68, 95% CI = 0.54–0.84) in CHF studies, and all-cause hospitalization (RR = 0.52, 95% CI = 0.32–0.83) in COPD studies. The inclusion of a cardiac nurse in the multidisciplinary team was associated with greater efficacy in reducing all-cause mortality among patients discharged after heart failure admission (HR = 0.64, 95% CI = 0.54–0.75 vs. HR = 0.87, 95% CI = 0.73–1.03).</jats:p> </jats:sec> <jats:sec id="sec005"> <jats:title>Conclusions</jats:title> <jats:p>Post-discharge interventions reduced all-cause mortality, cause-specific mortality, and cause-specific hospitalization in CHF patients and all-cause hospitalization in COPD patients. The presence of a cardiac nurse was associated with greater efficacy in included studies. Additional research is needed on the impact of post-discharge intervention strategies in COPD and CKD patients.</jats:p> </jats:sec>
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