Al Sattouf Aya, Farahat Rasha, Khatri Aayesha A
Medicine, West Suffolk NHS (National Health Service) Foundation Trust, Suffolk, GBR.
Haematology, King's College NHS (National Health Service) Foundation Trust, London, GBR.
Cureus. 2022 Sep 29;14(9):e29726. doi: 10.7759/cureus.29726. eCollection 2022 Sep.
Heart failure is a leading cause of hospitalizations. Heart failure patients were found to have a high incidence of re-admission after discharge. This highlights a care gap during the transition from hospital to home environment and interventions were utilized to cover this care gap. The aim of this review was to evaluate the effectiveness of these interventions. This was investigated in terms of re-admissions, mortality, emergency department (ED) visits, and quality of life. An exhaustive systematic search was conducted in electronic databases, which include MEDLINE, CINAHL, AMED, Cochrane library, and PubMed. Databases were explored for literature published in English between April 2012 and April 2022. The review included 13 randomized controlled trials and comprised a total of 7,693 heart failure patients with 3,835 receiving transitional care interventions (TCIs) and 3,858 receiving standard care. It was found that implementing TCIs resulted in a reduction of all-cause re-admission and all-cause mortality. Although it is controversial if TCIs improve quality of life, TCIs were noted to decrease the frequency of ED visits. Telephone support interventions proved most efficacious among other interventions in reducing hospital readmissions, and were found effective in reducing mortality in combination with other interventions, i.e. clinic visits. Additionally, telemonitoring is found beneficial in supporting patients just after discharge, the most vulnerable period, for medically optimizing and monitoring patients during the care gap.
心力衰竭是住院治疗的主要原因。研究发现，心力衰竭患者出院后再次入院的发生率很高。这凸显了从医院到家庭环境过渡期间的护理缺口，因此采用了干预措施来弥补这一护理缺口。本综述的目的是评估这些干预措施的有效性。从再次入院、死亡率、急诊科就诊次数和生活质量方面对其进行了调查。在包括MEDLINE、CINAHL、AMED、Cochrane图书馆和PubMed在内的电子数据库中进行了详尽的系统检索。检索了2012年4月至2022年4月期间以英文发表的文献。该综述纳入了13项随机对照试验，共7693名心力衰竭患者，其中3835名接受过渡性护理干预（TCI），3858名接受标准护理。研究发现，实施TCI可降低全因再次入院率和全因死亡率。尽管TCI是否能改善生活质量存在争议，但TCI可减少急诊科就诊次数。在减少医院再入院方面，电话支持干预在其他干预措施中被证明最为有效，并且与其他干预措施（如门诊就诊）相结合时，在降低死亡率方面也被证明有效。此外，远程监测被发现有利于在出院后这一最脆弱时期为患者提供支持，以便在护理缺口期间对患者进行医疗优化和监测。
