Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis

Autor: Nicole Askin, Ruchi Chhibba, Thomas W. Ferguson, Navdeep Tangri, Claudio Rigatto, Paul Komenda, Ryan J. Bamforth, Jenna M. Sabourin, Domenic Pieroni
Rok vydání: 2021
Předmět:
Pulmonology
Epidemiology
Health Care Providers
Nurses
law.invention
Pulmonary Disease
Chronic Obstructive
Mathematical and Statistical Techniques
Randomized controlled trial
law
Cause of Death
Patient-Centered Care
Medicine and Health Sciences
Risk of mortality
Medical Personnel
Randomized Controlled Trials as Topic
COPD
education.field_of_study
Multidisciplinary
Statistics
Metaanalysis
Patient Discharge
Professions
Meta-analysis
Physical Sciences
Medicine
Research Article
medicine.medical_specialty
Patients
Science
Chronic Obstructive Pulmonary Disease
Population
Cardiology
Research and Analysis Methods
Patient Readmission
Physicians
Internal medicine
medicine
Humans
Statistical Methods
Renal Insufficiency
Chronic
education
Primary Care
Heart Failure
business.industry
medicine.disease
Health Care
Medical Risk Factors
Heart failure
Relative risk
People and Places
Quality of Life
Population Groupings
business
Mathematics
Kidney disease
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 4, p e0249542 (2021)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0249542
Popis: Background Readmission following hospital discharge is common and is a major financial burden on healthcare systems. Objectives Our objectives were to 1) identify studies describing post-discharge interventions and their efficacy with respect to reducing risk of mortality and rate of hospital readmission; and 2) identify intervention characteristics associated with efficacy. Methods A systematic review of the literature was performed. We searched MEDLINE, PubMed, Cochrane, EMBASE and CINAHL. Our selection criteria included randomized controlled trials comparing post-discharge interventions with usual care on rates of hospital readmission and mortality in high-risk chronic disease patient populations. We used random effects meta-analyses to estimate pooled risk ratios for all-cause and cause-specific mortality as well as all-cause and cause-specific hospitalization. Results We included 31 randomized controlled trials encompassing 9654 patients (24 studies in CHF, 4 in COPD, 1 in both CHF and COPD, 1 in CKD and 1 in an undifferentiated population). Meta-analysis showed post-discharge interventions reduced cause-specific (RR = 0.71, 95% CI = 0.63–0.80) and all cause (RR = 0.90, 95% CI = 0.81–0.99) hospitalization, all-cause (RR = 0.73, 95% CI = 0.65–0.83) and cause-specific mortality (RR = 0.68, 95% CI = 0.54–0.84) in CHF studies, and all-cause hospitalization (RR = 0.52, 95% CI = 0.32–0.83) in COPD studies. The inclusion of a cardiac nurse in the multidisciplinary team was associated with greater efficacy in reducing all-cause mortality among patients discharged after heart failure admission (HR = 0.64, 95% CI = 0.54–0.75 vs. HR = 0.87, 95% CI = 0.73–1.03). Conclusions Post-discharge interventions reduced all-cause mortality, cause-specific mortality, and cause-specific hospitalization in CHF patients and all-cause hospitalization in COPD patients. The presence of a cardiac nurse was associated with greater efficacy in included studies. Additional research is needed on the impact of post-discharge intervention strategies in COPD and CKD patients.
Databáze: OpenAIRE
Externí odkaz: