Outpatient Follow-Up Visits to Reduce 30-Day All-Cause Readmissions for Heart Failure, COPD, Myocardial Infarction, and Stroke: A Systematic Review and Meta-Analysis

Abstract

Introduction: Hospital readmissions is an important public health problem that US hospitals are responsible for reducing. One strategy for preventing readmissions is to schedule an outpatient follow-up visit before discharge. The objective of this study was to determine whether outpatient follow-up visits are an effective method to reduce 30-day all-cause readmissions for patients discharged from US hospitals with heart failure, chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI), or stroke.

Methods: We conducted a systematic review and meta-analysis to identify relevant articles published from 2013 through 2023. We searched PubMed, CINAHL, and Cochrane. Eligible studies were those that assessed the effect of postdischarge outpatient follow-up visits on 30-day all-cause readmission. We used random effect meta-analyses to generate pooled adjusted effect estimates and 95% CIs.

Results: We initially identified 2,256 articles. Of these, 32 articles underwent full-text review and 15 met inclusion criteria. Seven studies addressed heart failure, 3 COPD, 2 AMI, and 3 stroke. Ten articles provided sufficient information for meta-analysis. The pooled adjusted effect measure was 0.79 (95% CI, 0.69-0.91), indicating that outpatient follow-up visits were associated with a 21% lower risk of readmission. However, we found a high degree of between-study heterogeneity (Q = 122.78; P < .001; I² = 92.7%). Subgroup analyses indicated that study quality, disease condition, and particularly whether a time-dependent analysis method was used, explained much of the heterogeneity.

Conclusion: Outpatient follow-up visits are a potentially effective way to reduce 30-day all-cause readmissions for patients discharged with heart failure or stroke, but evidence of benefit was lacking for COPD and we found no studies for assessing AMI. Our results emphasize the importance of study quality.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram of systematic review of US studies of outpatient follow-up visits and reduction of 30-day all-cause readmissions among patients with heart failure, chronic obstructive pulmonary disease, acute myocardial infarction, or stroke. Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.

Figure 2

Random effect meta-analysis showing the pooled summary estimate of all 10 Tier 1 studies. The size of the data markers (squares) corresponds to the weight of the study in the meta-analysis. Abbreviations: HR, hazard ratio; OR, odds ratio.

Figure 3

Random effect meta-analysis showing the pooled effect estimates for 3 subgroups.