Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 May 10;6(5):e010933.
doi: 10.1136/bmjopen-2015-010933.

Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

A L Huntley  1 , R Johnson  1 , A King  1 , R W Morris  1 , S Purdy  1
Affiliations
Meta-Analysis

Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

A L Huntley et al. BMJ Open. .

Abstract

Objectives: The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).

Setting: CM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.

Participants: Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.

Intervention: CM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems.

Primary and secondary outcomes: Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources.

Results: 22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference -1.28 days (95% CI -2.04 to -0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions.

Conclusions: Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.

Keywords: case management; hospital admission; meta-analysis; systematic review.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flow diagram. CCT, controlled clinical trial; CHF, chronic heart failure; CM, case management; EOL, end of life; RCT, randomised controlled trial.
Figure 2
Figure 2
(A) Risk of bias of included randomised controlled trials. (B) Effective Practice and Organisation of Care (EPOC) risk of bias for non-randomised controlled trials.
Figure 3
Figure 3
Chronic heart failure (CHF) admissions data. CM, case management.
Figure 4
Figure 4
Chronic heart failure (CHF) length of hospital stay. CM, case management.
See this image and copyright information in PMC

References

    1. Cardiovascular disease statistics 2014 British Heart Foundation. https://www.bhf.org.uk/~/media/files/publications/research/bhf_cvd-stati... on the 7/10/2015.
    1. Quality and Outcomes Framework Achievement, prevalence and exceptions data 2012/13. 29 October 2013. http://www.hscic.gov.uk/catalogue/PUB12262/qual-outc-fram-12-13-rep.pdf on the 7/10/2015.
    1. de Giuli F, Khaw KT, Cowie MR et al. Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom. Eur J Heart Fail 2005;7:295–302. 10.1016/j.ejheart.2004.10.017 - DOI - PubMed
    1. Stewart S, MacIntyre K, Hole DJ et al. More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 2001;3:315–22. - PubMed
    1. Stewart S, Ekman I, Ekman T et al. Population impact of heart failure and the most common forms of cancer: a study of 1 162 309 hospital cases in Sweden (1988 to 2004). Circ Cardiovasc Qual Outcomes 2010;3:573–80. 10.1161/CIRCOUTCOMES.110.957571 - DOI - PubMed

MeSH terms