Transitional care interventions may improve outcomes following hospital discharge for heart failure

A systematic review from the Agency for Healthcare Research and Quality (AHRQ) suggests transitional care interventions may reduce all-cause readmissions and mortality rates among patients with heart failure.

The researchers, who evaluated 47 studies published from 1990 to Oct. 29, 2013, said that as many as a quarter of patients hospitalized with heart failure are readmitted within 30 days. They defined preventable readmissions as those occurring within 30 days of discharge and that are clinically related to the previous admission.

They defined transitional care interventions as “a set of actions designed to ensure the coordination and continuity of healthcare as patients transfer from the inpatient setting to alternative care.” Examples include home-visiting programs, structured telephone support, telemonitoring, outpatient clinic-based interventions and educational interventions.

Guidelines from the American College of Cardiology and American Heart Association recommend hospitals provide educational materials to patients before they are discharged. They also recommend patients attend a follow-up visit within seven to 14 days of discharge.

The review found only a few studies that evaluated 30-day readmission rates. However, the available evidence suggests that home-visiting programs may reduce all-cause readmissions, according to the AHRQ researchers.

More studies evaluated outcomes three to six months after discharge. During that time period, home-visiting programs reduced all-cause readmissions, heart failure-specific readmissions, mortality and the composite of all-cause readmission or death. Meanwhile, multidisciplinary heart failure clinic-based interventions reduced all-cause readmissions and mortality, structured telephone support reduced heart failure-specific readmissions and mortality, and multicomponent interventions reduced all-cause readmissions and mortality.

For the multicomponent interventions, the researchers said the most effective interventions included heart failure education emphasizing self-care, heart failure pharmacotherapy emphasizing adherence, face-to-face contact after hospital discharge, mechanisms for postdischarge medication adjustment and streamlined mechanisms to contact care delivery personnel.

The researchers added that readmission rates varied by geographic location and health insurance coverage. Thus, they suggested that hospitals, health systems, insurers and patients better understand patient-level factors before deciding which transitional care interventions to recommend.