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Active telephone follow-up reduced mortality in chronic HF patients
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Case management-type interventions led by a heart failure specialist nurse reduced chronic heart failure-related readmissions, all-cause readmissions and all-cause mortality after 1 year of follow-up, according to results of a review of 25 randomized controlled trials comparing disease management interventions vs. usual care.
The review comprised 5,942 patients who were followed for at least 6 months in each of the trials.
A team of researchers in Australia and the United Kingdom found that patients with chronic HF (CHF) who received case-management interventions, including intensive monitoring by telephone calls and home visits, had less all-cause mortality 1 year after discharge vs. patients who received usual care (OR=0.66; 95% CI, 0.47-0.91). The same reduction was not seen at 6 months. CHF-related and CV-related mortality were not reduced.
Case-management interventions also reduced CHF-related readmissions at 6 months (OR=0.64; 95% CI, 0.46-0.88) and 1 year (OR=0.47; 95% CI, 0.3-0.76). The researchers said the impact of these interventions on all-cause readmissions was only apparent at 1 year (OR=0.75; 95% CI, 0.57-0.99).
Two studies examined multidisciplinary follow-up, for which a team of professionals bridged the gap between hospital admission and living at home. In these, there were fewer all-cause deaths vs. usual care.
Follow-up in a specialized CHF clinic was assessed in six trials. The researchers found no difference in all-cause mortality and readmission rates vs. usual care. However, both all-cause mortality (OR=0.46; 95% CI, 0.46-0.69) and CHF-related mortality (OR=0.45; 95% CI, 0.28-0.72) were reduced, according to the abstract.
Disclosure: The researchers report no relevant financial disclosures.
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