New evidence on how to help people with chronic heart failure stay out of hospital

There’s such a lot of interesting and important evidence from the latest batch of reviews. Two updated reviews are featured this week in the BMJ. The first of these, from the Cochrane Heart Group, assessed the effectiveness of disease management interventions for patients with chronic heart failure (CHF), a serious condition affecting mostly elderly people, which is becoming increasingly common as our population ages.

Key message: case management interventions reduced death rates and hospital readmissions in chronic heart failure patients.

People with CHF are at high risk of needing emergency admission to hospital and of dying. The review looked at the effectiveness of three different ways of monitoring patients who had previously been admitted to hospital with CHF: – case management interventions (typically involving a nurse intensively monitoring patients through phone calls and home visits)

– clinic interventions with follow-up in a specialist clinic

– multidisciplinary interventions, involving a team of different professionals

Evidence from 25 randomised controlled trials (16 new in this update) with almost 6000 people, followed up for at least six months, showed that case management interventions were associated with a reduction in death from all causes at 12 months and CHF related readmissions at six and twelve months. No reductions were seen for deaths from CHF or cardiovascular causes. Clinic interventions produced non-significant reductions in death from all causes and in readmissions for CFH and all causes. Only two studies looked at multidisciplinary interventions and found readmissions were reduced but not death rates.

The limited evidence available on health-related quality of life did not show that any of these interventions offered significant benefits in this respect, compared with ‘usual care’. The reviewers suggest that this outcome should be addressed in future trials.

The findings are based on high quality evidence as overall the studies were judged to be at low risk of bias.

Review author Stephanie Taylor told the BMJ “I think there is enough evidence to say that case management is effective. We now need more research on implementation and cost effectiveness.”

Links: Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M. Clinical service organisation for heart failure. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD002752. DOI: 10.1002/14651858.CD002752.pub3.

This review is featured on The Cochrane Collaboration website: http://www.cochrane.org/features/clinical-service-organisation-heart-failure

Cochrane summary: http://summaries.cochrane.org/CD002752/clinical-service-organisation-following-hospital-discharge-for-adults-with-chronic-heart-failure

Cochrane review says telephone follow-up of heart failure patients is effective. BMJ2012;345:e6187 (Published 14 September 2012)

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