Clinical outcomes in heart failure monitoring: a pooled rates analysis

Abstract

Objective: To understand clinical and health economic outcomes in patients receiving standard-of-care (SOC), out-of-hospital management for recently diagnosed heart failure (HF) in the US.

Study design: Systematic literature review with a subsequent pooled rates analysis.

Methods: Researchers reviewed randomized controlled trials (RCTs) indexed in PubMed and EMBASE between 2008 and 2023. RCTs were selected as the data sources because of the standardized reporting on outcomes and prospective data. Studies included in the analysis reported on US patients recently diagnosed with HF who underwent watchful waiting after discharge. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with details reported in the PROSPERO study protocol (No. CRD42023410084). The pooled estimates of all-cause and HF-specific hospital readmissions, length of hospital stay, emergency department visits, and mortality at 3, 6, and 12 months were calculated using R software's meta and metafor packages.

Results: There were 31 studies that met the inclusion criteria and reported data for 6916 patients with HF receiving SOC. The proportions of patients with a readmission and an emergency department visit at 3 months were 32.55% (95% CI, 24.03%-41.63%) and 13.83% (95% CI, 8.21%-20.49%), respectively. Mortality over the same period was 3.46%. Quality-of-life and cost data were heterogeneous and infrequently reported, preventing pooled analyses of these data. Length of stay had a pooled value of 7.12 days (95% CI, 5.78-8.46).

Conclusion: HF with SOC monitoring is associated with substantial health care burden. Improvements in SOC monitoring, potentially through remote monitoring and management, could be beneficial to patients, clinicians, and payers.