Avoiding Heart Failure Readmissions

A systematic review in the Annals of Internal Medicine examines whether various types of transitional care interventions might help prevent readmissions for people diagnosed with heart failure.  This population has a high number of hospitalizations and is heart failure is one of the readmission conditions in the CMS penalty program.  (Annals Article)   These transitional care interventions focus on improving the handoff from an acute care setting to outpatient services used when patient’s return to their residence.  The primary outcomes examined in the underlying studies were thirty-day readmission rates, readmissions within 3 to 6 months and mortality.  The interventions were divided into rough categories–home visiting programs, “simple telephone technology”, tele monitoring, outpatient clinic-based and primarily educational.  As might be expected, the meta-review is difficult because of heterogeneity in the interventions and the experimental designs and because the usual comparison is to usual care, which is not standardized.  Somewhere around 50 trials appear to have been used in the analysis.

The meta-analysis suggests that home visiting programs had a positive effect on readmissions over the 3-6 month time frame, as well as on mortality in that time frame.  Simple telephone interventions, i.e. frequent calls to check in on the patient seemed to have a similar effect.  Telemonitoring showed a moderate benefit in reducing 3-6 month readmissions but little effect on mortality or on 30 day readmissions.  An outpatient heart failure clinic intervention had a high effect on 30 day readmissions, but low effect on the other studied outcomes.  The other interventions had essentially no impact.  The good news is that it seems that some interventions can have an effect on readmissions and mortality.  For short-term readmission reduction, the heart failure specific outpatient clinic visits appeared to have a good effect.  For longer term effects, home visits and telephone-based monitoring seemed to be useful.  Designing a single effective program for all heart failure patients may be unrealistic.  And cost was not considered at all in this review.  While quality and better health should always be uppermost, knowing the cost effect on the system is also important.