Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis
Open accessAbstract
Aims: To compare the effectiveness of transitional care services in decreasing all-cause death and all-cause readmissions following hospitalization for heart failure (HF). Methods and results: We searched PubMed, Embase, CINAHL, and Cochrane Clinical Trials Register for randomized controlled trials (RCTs) published in 2000–2015 that tested the efficacy of transitional care services in patients hospitalized for HF, provided ≥1 month of follow-up, and reported all-cause mortality or all-cause readmissions. Our network meta-analysis included 53 RCTs (12 356 patients). Among services that significantly decreased all-cause mortality compared with usual care, nurse home visits were most effective [ranking P-score 0.6794; relative risk (RR) 0.78, 95% confidence intervals (CI) 0.62–0.98], followed by disease management clinics (DMCs) (ranking P-score 0.6368; RR 0.80, 95% CI 0.67–0.97). Among services that significantly decreased all-cause readmission, nurse home visits were most effective [ranking P-score 0.8365; incident rate ratio (IRR) 0.65, 95% CI 0.49–0.86], followed by nurse case management (NCM) (ranking P-score 0.6168; IRR 0.77, 95% CI 0.63–0.95), and DMCs (ranking P-score 0.5691; IRR 0.80, 95% CI 0.66–0.97). There was no significant difference in the comparative effectiveness of services that improved each outcome. Nurse home visits had the greatest pooled cost-savings (3810 USD, 95% CI 3682–3937), followed by NCM (3435 USD, 95% CI 3224–3645), and DMCs (245 USD, 95% CI −70 to 559). Telephone, telemonitoring, pharmacist, and education interventions did not significantly improve clinical outcomes. Conclusion: Nurse home visits and DMCs decrease all-cause mortality after hospitalization for HF. Along with NCM, they also reduce all-cause readmissions, with no significant difference in comparative effectiveness. These services reduce healthcare system costs to varying degrees.
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One review concluded that telephone or remote monitoring interventions compared to nurse home visits had no significant improvement on readmission or mortality in heart failure patients.
“one concluded that telephone or remote monitoring interventions compared to nurse home visits had no significant improvement on readmission or mortality in heart failure patients [26]”
From Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation (2020) · cites this paper as [26]
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2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
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- Authors
- Van Spall, H. G. C., Rahman, T., Mytton, O., Ramasundarahettige, C., Ibrahim, Q., Kabali, C., Coppens, M., Brian Haynes, R., & Connolly, S.
- Affiliations
- Department of Medicine, McMaster University, and Population Health Research Institute , Hamilton, ON ,
- McMaster University (CA)
- University of Cambridge (GB)
- Population Health Research Institute (CA)
- University of Toronto (CA)
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of Health Research Methods, Evidence, and Impact, McMaster University , Hamilton ,
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-02-24
- Volume
- 19
- Issue
- 11
- Pages
- 1427-1443
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2590357760
- Semantic Scholar
- c7c5b384fbd5cdaa0dae10065a4a3b0c9b1a09d2
- Cited by
- 381
- References
- 86
- Citations by year
- 2026: 33 · 2025: 38 · 2024: 46 · 2023: 54 · 2022: 55 · 2021: 51 · 2020: 45 · 2019: 32 · 2018: 19 · 2017: 8
- FWCI
- 4.01
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Ontario's Ministry of Health and Long Term Care (MOHLTC) Health System Research Fund
- Canadian Institutes of Health Research
- MOHLTC and Hamilton Health Sciences Career Research Award
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- heart failure, care transitions, home-visit nursing, nurse case management, hospital readmission, all-cause mortality, cost reduction, remote patient monitoring, pharmacist intervention, patient education, comparative effectiveness, post-discharge care, quality of life, health-related quality of life, patient satisfaction, patient-reported outcomes, patient-centered care, patient engagement, patient empowerment
- MeSH terms
- Transitional Care, Network Meta-Analysis, Heart Failure, Humans, Patient Readmission, Quality of Life, Telemedicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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