West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.
J Am Med Dir Assoc. 2021 Mar;22(3):621-629. doi: 10.1016/j.jamda.2020.09.019. Epub 2020 Nov 3.
Heart failure (HF) heavily burdens the global health system. Transitional care interventions attempt to streamline the hospital-to-home transition to ease the burden. This systematic review and meta-analysis aimed to evaluate the effectiveness of transitional care interventions on health care utilization after hospitalization for HF.
Systematic review and meta-analysis including dose-response relationship.
Randomized controlled trials (RCTs) of transitional care interventions vs usual care in older patients discharged from the hospital with HF.
Electronic databases including MEDLINE, Embase, Cochrane Library, and CINAHL, were systematically searched from January 2009 to October 2019 to locate relevant systematic reviews or meta-analyses. The original RCTs included in the review articles were identified, and an additional search for recently published RCTs was performed from January 2014 to June 2020. This systematic review focused on health care utilization outcomes, including hospital readmissions for HF or any cause, emergency department (ED) visits, and length of hospital stay (LOS).
Data were summarized from 38 RCTs covering 10,871 patients. Pooled evidence suggested a mean 11% [risk ratio (RR) 0.89, 95% confidence interval (CI) 0.82, 0.97] and 22% (RR 0.78, 95% CI 0.68, 0.89) risk reduction on all-cause and HF-specific readmissions, but no significant reduction (RR 0.94, 95% CI 0.83, 1.07) on ED visits. Findings were mixed for LOS. Subgroup analysis by different types of transitional care interventions indicated that multidisciplinary interventions currently have the best evidence for reducing readmissions up to 6 months post the index HF hospitalization. In addition, we observed an inverse linear dose-response relationship between intervention intensity (ie, frequency and duration of interventions) and complexity (ie, number of intervention components) and the risk of HF readmissions.
Transitional care interventions for hospitalized patients with HF reduced all-cause and HF-specific readmissions, but did not decrease ED visits. Multidisciplinary interventions are highly recommended if adequate resources are available.
心力衰竭（HF）给全球卫生系统带来了沉重负担。过渡性护理干预旨在简化从医院到家庭的过渡，以减轻负担。本系统评价和荟萃分析旨在评估过渡性护理干预对 HF 住院患者出院后医疗保健利用的影响。
系统评价和荟萃分析，包括剂量-反应关系。
对从医院出院的 HF 老年患者进行过渡性护理干预与常规护理的随机对照试验（RCT）。
系统检索 2009 年 1 月至 2019 年 10 月 MEDLINE、Embase、Cochrane 图书馆和 CINAHL 等电子数据库，以确定相关系统评价或荟萃分析。从综述文章中确定纳入的原始 RCT，并从 2014 年 1 月至 2020 年 6 月进行最近发表的 RCT 的额外搜索。本系统评价主要关注医疗保健利用结局，包括 HF 或任何原因的住院再入院、急诊科（ED）就诊和住院时间（LOS）。
汇总了 38 项 RCT，涵盖 10871 例患者的数据。汇总证据表明，全因和 HF 特异性再入院的风险分别降低了 11%（RR 0.89，95%置信区间[CI] 0.82，0.97）和 22%（RR 0.78，95%CI 0.68，0.89），但 ED 就诊的风险无显著降低（RR 0.94，95%CI 0.83，1.07）。LOS 的结果不一。不同类型过渡性护理干预的亚组分析表明，多学科干预目前在降低 HF 住院后 6 个月内的再入院率方面具有最佳证据。此外，我们观察到干预强度（即干预的频率和持续时间）和复杂性（即干预成分的数量）与 HF 再入院风险之间呈负线性剂量-反应关系。
HF 住院患者的过渡性护理干预可降低全因和 HF 特异性再入院率，但不会降低 ED 就诊率。如果有足够的资源，强烈推荐多学科干预。
