Table 7: Summary of Recent Studies Not Included in Systematic Reviews.
| Author, Year, Country | Intervention | Control | Results | Limitations |
|---|---|---|---|---|
| Atienza et al, 2004(59) Spain | n = 164 Patients and families received a predischarge formal education about disease from cardiac nurse Visit with primary care physician scheduled within 2 weeks of discharge Regular follow-up visits at the outpatient Heart Failure Clinic scheduled for every 3 months 24-hour phone contact number available to patients from discharge to end of study if patients experienced worsening symptoms |
n = 174 Discharge planning according to the routine protocol of the study hospitals |
Event-free survival Reduction of 47 events per 100 patients (95% CI, 29–65), P < 0.001 per year of observation in intervention patients Readmissions Reduction of 16% (95% CI, 4%–28%), P = 0.004 in rate of readmitted patients for any cause in intervention group Reduction of 37 all-cause readmissions per 100 patients (95% CI, 21–53), P < 0.001 per year of observation for intervention group Reduction of 19% (95% CI, 0.09–0.29), P < 0.001 in rate of readmitted patients for HF in intervention group Mortality Reduction of 10 deaths per 100 patients (95% CI, 0.02–0.18), P = 0.006 per observation year for intervention patients HRQOL at 1 year (Minnesota Quality of Life Score) Significantly higher improvement in intervention group (P = 0.01) |
Unable to identify which elements of the intervention are responsible beneficial results |
| Naylor et al, 2004 (56) United States |
n = 118 Comprehensive discharge planning and home follow-up directed by APNs APN visited at least daily during index hospitalization At least 8 APN home visits (one within 24 hours of discharge) Weekly visits during the first month (with one visit coinciding with the initial follow-up visit to the patient’s physician); bimonthly visits during the second and third months. Additional APN visits based on patients’ needs APN available by telephone 7 days/week |
n = 121 Usual care for the control group included site-specific HF-patient management and discharge planning critical paths, and if referred, standard home agency care consisting of comprehensive skilled home health services 7 days a week. |
Time to first rehospitalization or death Longer in intervention patients (log rank χ2 = 5.0, P = 0.03) Rehospitalization or death at 52 weeks Intervention (n = 118 patients) vs. control (n = 121 patients) 56 (48%) vs. 74 patients (61%), P = 0.01 Patients rehospitalized (1 time) Intervention (n = 118 patients) vs. control (n = 121 patients) 53 (44.9%) vs. 67 (55.4%), P = 0.12; RR, 1.24 (95% CI, 0.95–1.60) Rehospitalizations at 1 year Intervention (n = 104 rehospitalizations) vs. control (n = 162 rehospitalizations) Index related: 40 vs. 72, P = 0.18 Comorbidity related: 23 vs. 50, P = 0.01 New health problem: 41 vs. 40, P = 0.88 HRQOL At 12 weeks, intervention group reported greater overall HRQOL (P < 0.05) No significant difference observed at other time points Functional status No significant difference observed at any time point Satisfaction with care Greater in intervention patients at 2 and 6 weeks (P < 0.001) No other time periods reported |
Significantly more patients with hypertension in the control group than the treatment group, 71/121 (59%) vs. 54/121 (45%); P = 0.04 The primary outcome was time to first event (a combination of any cause readmission or death). There may not have been sufficient statistical power for assessment of some secondary outcomes e.g., patients rehospitalized or index-related rehospitalization at 1 year |
| Kwok et al, 2008 (57) China |
n = 49 Community nurse visited before discharge, within 7 days of discharge, weekly for 4 weeks, then monthly Community nurses worked closely with designated hospital geriatricians or cardiologists; counselled patients on drug compliance and diet; encouraged patients to contact nurse via telephone hotline during office hours if symptoms developed |
n = 56 Patients received usual care and follow-up in hospital outpatient clinics by same group of designated geriatricians or cardiologists used by intervention patients |
6-month readmission rate No significant difference between intervention and control groups (46% and 57%, respectively, P = 0.23) Authors reported no significant difference for primary causes of readmission (no statistical test reported) Unplanned readmissions No significant difference (intervention: median 0 [quartile range 0, 1] vs. control: median 1 [quartile range 0, 2], P = 0.06) Functional status (6MWT) No significant difference between study groups London Handicap Scale (6 domains) Compared with controls, intervention group became significantly less limited in independence (median change in independence domain score 0 vs. 0.5, P < 0.005). No significant difference observed in other 5 domains |
Intent-to-treat analysis not reported At baseline, more patients in intervention group receiving social security assistance than control group (23/49 [47%] vs. 14/56 [25%], respectively) Statistical comparisons not reported for baseline characteristics |
| Zhao et al, 2009 (58) China |
n = 100 A hospital nurse was responsible for the predischarge phase and 2 nurses in a community hospital were responsible for the postdischarge phase Key areas addressed were patients’ understanding of and adherence to diet, medications, exercise, and health-related lifestyle Based on referral report from the hospital nurse, community nurses continued to follow-up the patients for 4 weeks via 2 home visits and 2 telephone calls. |
n = 100 Physician talked to patients about special points that needed attention on returning home Free educational pamphlets on maintaining healthy eating and lifestyles were made available to patients |
Endpoints measured at 2 days, 4 weeks, and 12 weeks postdischarge Patients in study group had significantly better understanding of diet, medications, and health-related lifestyle behaviour at 2 days, 4 weeks, and 12 weeks postdischarge and better understanding of exercise at weeks 4 and 12 Significant differences favouring intervention group in adherence to diet and health-related lifestyle at day 2, 4 weeks, and 12 weeks, medication at 4 and 12 weeks, and exercise at week 12 No significant difference between study groups for hospital readmission 82% of intervention patients considered community nursing follow-up very helpful, and 80% expressed high satisfaction with service Patient satisfaction not reported for control group |
Instruments used to measure patient understanding, adherence and satisfaction were not standardized, validated measurement scales Outcome measures relied on self-reporting by patients. Data regarding extent of cardiovascular risk for the patients were not reported (e.g., weight, blood pressure, diabetes, etc.). |
Abbreviations: χ2, chi-square; 6MWT, 6-minute walking test; APN, Advanced Practice Nurses; CI, confidence interval; HF, heart failure; HRQOL, health-related quality of life; RR, relative risk.