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. 2022 Sep;27(5):1683-1748.
doi: 10.1007/s10741-021-10212-8. Epub 2022 Mar 3.

Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

Frederique J Hafkamp  1 , Rene A Tio  2   3 , Luuk C Otterspoor  2   3 , Tineke de Greef  2   3 , Gijs J van Steenbergen  3 , Arjen R T van de Ven  2   4 , Geert Smits  2   5 , Hans Post  2   3 , Dennis van Veghel  2   3
Affiliations

Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

Frederique J Hafkamp et al. Heart Fail Rev. 2022 Sep.

Abstract

Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.

Keywords: Care pathways; Heart failure related hospitalizations; Interventions; Invasive therapy; Medication; Rehabilitations.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study inclusion. RCT: randomized controlled trial
Fig. 2
Fig. 2
Effects of different interventions on HF-related hospitalization in meta-analyzed and single-study results. ACE, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blockers; MRA, mineralocorticoid receptor antagonists; CR, cardiac rehabilitation; CRT, cardiac resynchronization therapy; CA, catheter ablation; TM, telemonitoring; STS, structured telephone support
Fig. 3
Fig. 3
Forest plot of RR for HF-related hospitalization between cardiac rehabilitation and control. Random effects model
Fig. 4
Fig. 4
(A–D) Forest plots of RR for HF-related hospitalization between (A) catheter ablation, (B) cardiac resynchronization therapy, (C) mitral valve therapy, and (D) stem cell therapy, and control. Fixed effects model
Fig. 4
Fig. 4
(A–D) Forest plots of RR for HF-related hospitalization between (A) catheter ablation, (B) cardiac resynchronization therapy, (C) mitral valve therapy, and (D) stem cell therapy, and control. Fixed effects model
Fig. 5
Fig. 5
(A–F) Forest plots of RR for HF-related hospitalization between (A) angiotensin-converting enzyme inhibitors, (B) angiotensin II receptor blockers, (C) mineralocorticoid receptor antagonists, (D) beta-blockers, (E) statins, and (F) anticoagulation, and control. Fixed effects model
Fig. 5
Fig. 5
(A–F) Forest plots of RR for HF-related hospitalization between (A) angiotensin-converting enzyme inhibitors, (B) angiotensin II receptor blockers, (C) mineralocorticoid receptor antagonists, (D) beta-blockers, (E) statins, and (F) anticoagulation, and control. Fixed effects model
Fig. 6
Fig. 6
(A–C) Forest plot of RR for HF-related hospitalization between (A) multidisciplinary clinics or self-management promotion programs, (B) structured telephone support, and (C) telemonitoring, and control. Fixed effects model
Fig. 7
Fig. 7
(A–D) Funnel plots of the effects of (A) cardiac rehabilitation, (B) telemonitoring, (C) medication, and (D) invasive therapy
Fig. 7
Fig. 7
(A–D) Funnel plots of the effects of (A) cardiac rehabilitation, (B) telemonitoring, (C) medication, and (D) invasive therapy
Fig. 7
Fig. 7
(A–D) Funnel plots of the effects of (A) cardiac rehabilitation, (B) telemonitoring, (C) medication, and (D) invasive therapy
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