What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review

BMC Cardiovascular Disorders

Research Article

Voltaire Nadurata¹  Nicholas Cox²  Andrea Driscoll³  Karen Page³  Sharon Meagher³  Rhoda Kennedy³  David Hare⁴  Melanie Hay⁵  Harry Patsamanis⁵  Donald Campbell⁶  Debra Gascard⁷  Jayant Banerji⁸  Rhonda Sanders⁹ 

[1] Cardiology Department, Bendigo Health, Victoria, Australia;Cardiology Department, Western Health, Gordon Street, Footscray, 3011, Melbourne, Australia;Deakin University, Locked Bag 20000, 3220, Geelong, VIC, Australia;Department of Cardiology, University of Melbourne and Austin Health, Burgundy St Heidelberg, 3081, Melbourne, Australia;Heart Foundation (Victoria), Level 12, 500 Collins st, 3000, Melbourne, Australia;Monash Health, Clayton, Melbourne, Australia;Monash Health, Monash Health Community, Dandenong, Melbourne, Australia;School of Rural Health, Monash University, Bendigo, Victoria, Australia;St Vincent’s Hospital, Victoria parade, Melbourne, Australia;

关键词: Heart failure;    Systems of care;    Hospital readmissions;    Primary care;    Hospitalisations;    Transitional care;    Workforce;    Systematic review;   

DOI  :  10.1186/s12872-016-0371-7

 received in 2016-05-21, accepted in 2016-09-28,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundHospital admissions for heart failure are predicted to rise substantially over the next decade placing increasing pressure on the health care system. There is an urgent need to redesign systems of care for heart failure to improve evidence-based practice and create seamless transitions through the continuum of care. The aim of the review was to examine systems of care for heart failure that reduce hospital readmissions and/or mortality.MethodElectronic databases searched were: Ovid MEDLINE, EMBASE, CINAHL, grey literature, reviewed bibliographies and Cochrane Central Register of Controlled Trials for randomised controlled trials, non-randomised trials and cohort studies from 1st January 2008 to 4th August 2015. Inclusion criteria for studies were: English language, randomised controlled trials, non-randomised trials and cohort studies of systems of care for patients diagnosed with heart failure and aimed at reducing hospital readmissions and/or mortality.Three reviewer authors independently assessed articles for eligibility based on title and abstract and then full-text. Quality of evidence was assessed using Newcastle-Ottawa Scale for non-randomised trials and GRADE rating tool for randomised controlled trials.ResultsWe included 29 articles reporting on systems of care in the workforce, primary care, in-hospital, transitional care, outpatients and telemonitoring. Several studies found that access to a specialist heart failure team/service reduced hospital readmissions and mortality. In primary care, a collaborative model of care where the primary physician shared the care with a cardiologist, improved patient outcomes compared to a primary physician only. During hospitalisation, quality improvement programs improved the quality of inpatient care resulting in reduced hospital readmissions and mortality. In the transitional care phase, heart failure programs, nurse-led clinics, and early outpatient follow-up reduced hospital readmissions. There was a lack of evidence as to the efficacy of telemonitoring with many studies finding conflicting evidence.ConclusionRedesigning systems of care aimed at improving the translation of evidence into clinical practice and transitional care can potentially improve patient outcomes in a cohort of patients known for high readmission rates and mortality.

【 授权许可】

CC BY   
© The Author(s). 2016