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
. 2021 Apr 22;16(4):e0249542.
doi: 10.1371/journal.pone.0249542. eCollection 2021.

Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis

Ryan J Bamforth  1   2 , Ruchi Chhibba  1   2 , Thomas W Ferguson  1   2 , Jenna Sabourin  1   2 , Domenic Pieroni  1   2 , Nicole Askin  1 , Navdeep Tangri  1   2 , Paul Komenda  1   2 , Claudio Rigatto  1   2
Affiliations
Meta-Analysis

Strategies to prevent hospital readmission and death in patients with chronic heart failure, chronic obstructive pulmonary disease, and chronic kidney disease: A systematic review and meta-analysis

Ryan J Bamforth et al. PLoS One. .

Abstract

Background: Readmission following hospital discharge is common and is a major financial burden on healthcare systems.

Objectives: Our objectives were to 1) identify studies describing post-discharge interventions and their efficacy with respect to reducing risk of mortality and rate of hospital readmission; and 2) identify intervention characteristics associated with efficacy.

Methods: A systematic review of the literature was performed. We searched MEDLINE, PubMed, Cochrane, EMBASE and CINAHL. Our selection criteria included randomized controlled trials comparing post-discharge interventions with usual care on rates of hospital readmission and mortality in high-risk chronic disease patient populations. We used random effects meta-analyses to estimate pooled risk ratios for all-cause and cause-specific mortality as well as all-cause and cause-specific hospitalization.

Results: We included 31 randomized controlled trials encompassing 9654 patients (24 studies in CHF, 4 in COPD, 1 in both CHF and COPD, 1 in CKD and 1 in an undifferentiated population). Meta-analysis showed post-discharge interventions reduced cause-specific (RR = 0.71, 95% CI = 0.63-0.80) and all cause (RR = 0.90, 95% CI = 0.81-0.99) hospitalization, all-cause (RR = 0.73, 95% CI = 0.65-0.83) and cause-specific mortality (RR = 0.68, 95% CI = 0.54-0.84) in CHF studies, and all-cause hospitalization (RR = 0.52, 95% CI = 0.32-0.83) in COPD studies. The inclusion of a cardiac nurse in the multidisciplinary team was associated with greater efficacy in reducing all-cause mortality among patients discharged after heart failure admission (HR = 0.64, 95% CI = 0.54-0.75 vs. HR = 0.87, 95% CI = 0.73-1.03).

Conclusions: Post-discharge interventions reduced all-cause mortality, cause-specific mortality, and cause-specific hospitalization in CHF patients and all-cause hospitalization in COPD patients. The presence of a cardiac nurse was associated with greater efficacy in included studies. Additional research is needed on the impact of post-discharge intervention strategies in COPD and CKD patients.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram of the study selection process for the systematic review.
Fig 2
Fig 2. Meta-analysis of relative risks.
A) all-cause mortality, B) all-cause hospitalization, C) cause-specific mortality, D) cause-specific hospitalization in heart failure patients; E) all-cause mortality, F) all-cause hospitalization in COPD patients.
Fig 3
Fig 3. Subgroup analysis–presence and absence of a cardiac nurse in heart failure studies.
See this image and copyright information in PMC

References

    1. van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551–7. 10.1503/cmaj.091117 - DOI - PMC - PubMed
    1. Canadian Institute for Health Information. All-cause readmission to acute care and return to the emergency department (Ottawa, ONT: CIHI; 2012). Available from: https://secure.cihi.ca/free_products/Readmission_to_acutecare_en.pdf
    1. Jencks S, Williams M, Coleman E. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2011;364(16):1582. - PubMed
    1. Yam CH, Wong EL, Chan FW, Wong FY, Leung MC, Yeoh EK. Measuring and preventing potentially avoidable hospital readmissions: a review of the literature. Hong Kong Med J. 2010;16(5):383–9. - PubMed
    1. Medicare Payment Advisory Commission. Report to the Congress: Reforming the Delivery System (Washington, DC: Medpac; 2008). Available from: http://www.medpac.gov/docs/default-source/reports/Jun08_EntireReport.pdf

Publication types

MeSH terms