Disease Management Interventions for Heart Failure

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).