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Evidence summaries

Disease Management Interventions for Heart Failure

Multidisciplinary interventions and case management type interventions led by a heart failure specialist nurse appear to reduce heart failure related hospitalizations and all cause mortality among patients who have previously been admitted to hospital for congestive heart failure. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment and blinding).

Summary

A Cochrane review [Abstract] 1 included 47 studies with a total of 10 869 subjects. Twenty-eight were case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits), 7 were clinic-based models (follow up in a congestive heart failure (CHF) clinic), 9 were multidisciplinary interventions (a holistic approach to the individuals' medical, psychosocial, behavioural and financial circumstances and typically involve several different professions working in collaboration), and 3 could not be categorised as any of these.

Mortality: Only 2 multidisciplinary-intervention studies reported mortality due to heart failure (RR 0.46, 95% CI 0.23 to 0.95, NNTB 12, 95% CI 9 to 126; 2 studies, n=277).Case management interventions (RR 0.78, 95% CI 0.68 to 0.90, NNTB 25, 95% CI 17 to 54; 26 studies, n=6 903) and multidisciplinary interventions (RR 0.67, 95% CI 0.54 to 0.83, NNTB 17, 95% CI 12 to 32; 8 studies, n=1 764) reduced all-cause mortality.Clinic-based studies had little to no difference to all-cause mortality (RR 0.87, 95% CI 0.68 to 1.10; 7 studies, n=1 686).

Heart failure readmissions: Case management interventions (RR 0.64, 95% CI 0.53 to 0.78, statistical heterogeneity I2 =51%; NNTB 8, 95% CI 6 to 13; 12 studies, n=2 528) and multidisciplinary interventions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44; 5 studies, n=1 108) reduced the risk of heart failure readmissions.There was little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18; 2 studies, n=887).

All-cause readmissions: Case management (RR 0.92, 95% CI 0.83 to 1.01; 14 studies, n=4 539; a decrease from 491 to 451 in 1000 people, 95% CI 407 to 495) and multidisciplinary interventions (RR 0.85, 95% CI 0.71 to 1.01; 5 studies, n=1 152; a decrease from 450 to 383 in 1000 people, 95% CI 320 to 455) seemed to slightly, but not statistically significantly, reduce all-cause readmissions. Clinic-based interventions resulted in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12, statistical heterogeneity I2 =65%; 4 studies, n=1 129).

Clinical comments

Note

Date of latest search:

    References

    • Takeda A, Martin N, Taylor RS et al. Disease management interventions for heart failure. Cochrane Database Syst Rev 2019;(1):CD002752. [PubMed]. [PubMed]

Primary/Secondary Keywords