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Meta-Analysis
. 2015 Jun 8;10(6):e0129282.
doi: 10.1371/journal.pone.0129282. eCollection 2015.

Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Amro Qaddoura  1 , Payam Yazdan-Ashoori  2 , Conrad Kabali  3 , Lehana Thabane  4 , R Brian Haynes  5 , Stuart J Connolly  6 , Harriette Gillian Christine Van Spall  6
Affiliations
Meta-Analysis

Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Amro Qaddoura et al. PLoS One. .

Abstract

Background: Heart failure (HF) is the commonest cause of hospitalization in older adults. Compared to routine hospitalization (RH), hospital at home (HaH)--substitutive hospital-level care in the patient's home--improves outcomes and reduces costs in patients with general medical conditions. The efficacy of HaH in HF is unknown.

Methods and results: We searched MEDLINE, Embase, CINAHL, and CENTRAL, for publications from January 1990 to October 2014. We included prospective studies comparing substitutive models of hospitalization to RH in HF. At least 2 reviewers independently selected studies, abstracted data, and assessed quality. We meta-analyzed results from 3 RCTs (n = 203) and narratively synthesized results from 3 observational studies (n = 329). Study quality was modest. In RCTs, HaH increased time to first readmission (mean difference (MD) 14.13 days [95% CI 10.36 to 17.91]), and improved health-related quality of life (HrQOL) at both, 6 months (standardized MD (SMD) -0.31 [-0.45 to -0.18]) and 12 months (SMD -0.17 [-0.31 to -0.02]). In RCTs, HaH demonstrated a trend to decreased readmissions (risk ratio (RR) 0.68 [0.42 to 1.09]), and had no effect on all-cause mortality (RR 0.94 [0.67 to 1.32]). HaH decreased costs of index hospitalization in all RCTs. HaH reduced readmissions and emergency department visits per patient in all 3 observational studies.

Conclusions: In the context of a limited number of modest-quality studies, HaH appears to increase time to readmission, reduce index costs, and improve HrQOL among patients requiring hospital-level care for HF. Larger RCTs are necessary to assess the effect of HaH on readmissions, mortality, and long-term costs.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Summary of evidence search and selection.
Fig 2
Fig 2. Hospital readmissions and all-cause mortality for HaH compared with inpatients in randomized controlled trials.
Fig 3
Fig 3. Hospital readmissions and emergency department visits per patient in substitutive versus inpatients in observational studies.
Fig 4
Fig 4. Health-related quality of life for HaH compared with inpatients at 6- and 12-month follow-up in randomized controlled trials.
See this image and copyright information in PMC

References

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