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Title: What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review
Austin Authors: Driscoll, Andrea ;Meagher, Sharon;Kennedy, Rhoda;Hay, Melanie;Banerji, Jayant;Campbell, Donald;Cox, Nicholas;Gascard, Debra;Hare, David L ;Page, Karen;Nadurata, Voltaire;Sanders, Rhonda;Patsamanis, Harry
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Deakin University, Geelong, Victoria, Australia
Heart Foundation (Victoria), Melbourne,Victoria, Australia
School of Rural Health, Monash University, Bendigo, Victoria, Australia
Monash Health, Clayton, Victoria, Australia
Cardiology Department, Western Health, Footscray, Victoria, Australia
Monash Health, Monash Health Community, Dandenong, Victoria, Australia
Department of Cardiology, University of Melbourne and Austin Health, Heidelberg, Victoria, Australia
Cardiology Department, Bendigo Health, Bendigo, Victoria, Australia
St Vincent's Hospital, Fitzroy, Victoria, Australia
Issue Date: 11-Oct-2016 2016-10-11
Publication information: BMC Cardiovascular Disorders 2016; 16(1): 195
Abstract: BACKGROUND: Hospital admissions for heart failure are predicted to rise substantially over the next decade placing increasing pressure on the health care system. There is an urgent need to redesign systems of care for heart failure to improve evidence-based practice and create seamless transitions through the continuum of care. The aim of the review was to examine systems of care for heart failure that reduce hospital readmissions and/or mortality. METHOD: Electronic databases searched were: Ovid MEDLINE, EMBASE, CINAHL, grey literature, reviewed bibliographies and Cochrane Central Register of Controlled Trials for randomised controlled trials, non-randomised trials and cohort studies from 1st January 2008 to 4th August 2015. Inclusion criteria for studies were: English language, randomised controlled trials, non-randomised trials and cohort studies of systems of care for patients diagnosed with heart failure and aimed at reducing hospital readmissions and/or mortality. Three reviewer authors independently assessed articles for eligibility based on title and abstract and then full-text. Quality of evidence was assessed using Newcastle-Ottawa Scale for non-randomised trials and GRADE rating tool for randomised controlled trials. RESULTS: We included 29 articles reporting on systems of care in the workforce, primary care, in-hospital, transitional care, outpatients and telemonitoring. Several studies found that access to a specialist heart failure team/service reduced hospital readmissions and mortality. In primary care, a collaborative model of care where the primary physician shared the care with a cardiologist, improved patient outcomes compared to a primary physician only. During hospitalisation, quality improvement programs improved the quality of inpatient care resulting in reduced hospital readmissions and mortality. In the transitional care phase, heart failure programs, nurse-led clinics, and early outpatient follow-up reduced hospital readmissions. There was a lack of evidence as to the efficacy of telemonitoring with many studies finding conflicting evidence. CONCLUSION: Redesigning systems of care aimed at improving the translation of evidence into clinical practice and transitional care can potentially improve patient outcomes in a cohort of patients known for high readmission rates and mortality.
DOI: 10.1186/s12872-016-0371-7
ORCID: 0000-0001-9554-6556
PubMed URL: 27729027
Type: Journal Article
Subjects: Heart failure
Transitional care
Patient readmission
Primary health care
Point of care systems
Type of Clinical Study or Trial: Systematic Reviews
Appears in Collections:Journal articles

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