chf interventions to decrease readmissions

recent systematic review/meta-analysis of interventions to prevent readmissions for pts with heart failure (see chf interventions to decrease readmissions annals2014 in dropbox, or Ann Intern Med. 2014;160:774-784). review was funded by Agency for Healthcare Research and Quality (AHRQ)

background:
    --heart failure (chf) is leading cause of hospitalizations (and health care utilization) in US
    --25% of pts admitted with chf are readmitted within 30 days (35% of them readmitted with diagnosis of chf. rest with renal dz, pneumonia, etc)

results:
    --47 trials of diverse interventions to prevent readmission. pts with moderate to severe chf. mean age 70.
    --at 30 days, high intensity home-visiting program (nurse or pharmacist usually) reduced all-cause readmission and combo of that plus death, though low quality of evidence
    --over 3-6 months, home-visiting program and multidisciplinary heart failure clinics reduced all-cause readmission, with high quality of evidence
    --structured telephone support (scheduled calls with structured questions, decision-support-software, etc) reduced chf-specific readmissions but not all-cause readmissions, with moderate quality of evidence
    --home-visiting programs, multidisciplinary heart failure clinics, and structured telephone support reduced mortality
    --BUT, neither telemonitoring (remote physiologic monitoring, eg with EKG, BP, weight, oxygen sats) nor educational programs (in person, or interactive computer-based) reduced readmission or mortality

so, not so surprising, though there is great local, regional, and national variability in post-hospital interventions. the results are certainly consistent with our anecdotal practice, that providing lots of nurse-based home visits (with occasional MD visits) and the availability of nurses to go to the house with minimal notice, decreases ER visits significantly and the seemingly inevitable readmission. seems that interventions with more human interaction (home visits, or even telephone support) do better than high-tech physiologic monitoring (telemonitoring). maybe not so surprising....

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