Table 2.
Randomized trials evaluating the effect of disease management programs on hospital readmission of older patients with heart failure.
| Author, Year | O/F | Main findings: intervention vs usual carec |
|---|---|---|
| DIAL, 2003[42,43] | A,B,C (1.2 years) | SI produced a 20% relative risk reduction on the combined end-point (HF hospital readmission or death, 26.3% vs 31%, P ¼ 0:02). SI decreased the number of patients with HF hospital readmission. |
| Laramee, 2003[44] | A,B (3 months) | readmission rates were equal for both groups (37%). Total inpatient and outpatient median costs and readmission median cost were reduced 14% and 26%, respectively, for the SI group. Subgroup analysis of patients who lived locally and saw a cardiologist showed a significant decrease in HF readmissions for the SI group. |
| Stromberg, 2003[45] | B,C (3 & 2 month) | There were fewer patients with the combined end-point (readmission or death) after 12 months in the SI group compared to the control group. The SI group had fewer re-admissions (33 vs 56, P ¼0.047) and days in hospital (350 vs 592, P ¼ 0:045) during the first 3 months. After 12 months the SI was associated with a 55% decrease in admissions/patient/month and fewer days in hospital/ patient/month. |
| Doughty, 2002[46] | A,B,C (1 year) | SI reduced total hospital readmissions and total bed days. The main effect of the intervention was attributable to the prevention of multiple re-admissions. SI improved quality of life |
| Harrison, 2002[47] | B (3 months) | In the SI group the percentage of patients readmitted was 23 vs 31 in the US group, 35 patients did not complete the study to 3 months. |
| Kasper, 2002[48] | A, B, C (6 months) | SI reduced the Combined endpoint (HF hospital readmission or death: 43 re-admissions and 7 deaths vs 59 and 13, The quality-of-life score, percentage of patients on target vasodilator therapy and percentage of patients Compliant with diet recommendations were significantly better in the SI group. |
| Krumholz, 2002[49] | A, B, C (1 year) | SI reduced the Combined endpoint (hospital readmission or death 25 vs 36. SI obtained a 39% decrease in the total number of readmissions. After adjusting for clinical and demographic characteristics, the SI group had a significantly lower risk of readmission. |
| McDonald, 2002[50] | A, C (3 months) | SI reduced the combined end-point (HF hospital readmission or HF death. HF readmission was far less frequent in the SI group (25.5% vs 3.9%) |
| Riegel, 2002[51] | A,B (3 & 6 months) | The HF hospitalization rate was 47.5% lower in the intervention group at 3 months and 47.8% lower at 6 months. HF hospital days were significantly lower in the intervention group at 6 months. A cost saving was realized even after intervention costs were deducted. There was no evidence of cost shifting to the outpatient setting. Patient satisfaction with care was higher in the intervention group |
| Stewart, 2002[52] | B,C (4.2 years) | There were significantly fewer unplanned readmissions and fewer combined end-points (unplanned readmission or death): a mean of 0.21 vs 0.37 events per patient per month. Mean event-free survival was more prolonged (7 vs 3 months). Assignment to intervention was both and independent predictor of event-free survival. |
| Blue, 2001[53] | A,B,C (1 year) | SI reduced the combined end-point (HF hospital admission or death. There were fewer readmissions for any reason (86 vs 114, P ¼ 0:018), fewer admissions for HF (19 vs 45, P < 0.001), and fewer days in hospital for HF (mean 3.43 vs 7.46 days) |