A Cochrane review included 25 studies with a total of 5 942 subjects. Interventions were classified by: (1) case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits); (2) clinic interventions (follow up in a congestive heart failure (CHF) clinic) and (3) multidisciplinary interventions (holistic approach bridging the gap between hospital admission and discharge home delivered by a team).
Seventeen studies reported a case-management intervention. Case management interventions were associated with reduction in all cause mortality at 12 months follow up (OR 0.66, 95% CI 0.47 to 0.91), but not at 6 months. No reductions were seen for deaths from CHF or cardiovascular causes. However, case management type interventions reduced CHF related readmissions at 6 month (OR 0.64, 95% CI 0.46 to 0.88) and 12 month follow up (OR 0.47, 95% CI 0.30 to 0.76). Impact of these interventions on all cause hospital admissions was not apparent at 6 months but was at 12 months (OR 0.75, 95% CI 0.57 to 0.99, statistical heterogeneity I2 = 58%). Telephone follow-up by a specialist nurse was a common feature of more successful programs.
Six studies looked at heart failure clinics. CHF clinic interventions (for 6 and 12 month follow up) revealed non-significant reductions in all cause mortality, CHF related admissions and all cause readmissions.
Mortality was not reduced in the 2 studies that looked at multidisciplinary interventions. However, both all cause and CHF related readmissions were reduced (OR 0.46, 95% CI 0.46 to 0.69, and 0.45, 95% CI 0.28 to 0.72, respectively).
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