title: Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis.
abstract: BACKGROUND
  Nearly 25% of patients hospitalized with heart failure (HF) are readmitted within 30 days.
  
  
  OBJECTIVE
  To assess the efficacy, comparative effectiveness, and harms of transitional care interventions to reduce readmission and mortality rates for adults hospitalized with HF.
  
  
  METHODS
  MEDLINE, Cochrane Library, CINAHL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (1 January 1990 to late October 2013).
  
  
  METHODS
  Two reviewers independently selected randomized, controlled trials published in English reporting a readmission or mortality rate within 6 months of an index hospitalization.
  
  
  METHODS
  One reviewer extracted data, and another checked accuracy. Two reviewers assessed risk of bias and graded strength of evidence (SOE).
  
  
  RESULTS
  Forty-seven trials were included. Most enrolled adults with moderate to severe HF and a mean age of 70 years. Few trials reported 30-day readmission rates. At 30 days, a high-intensity home-visiting program reduced all-cause readmission and the composite end point (all-cause readmission or death; low SOE). Over 3 to 6 months, home-visiting programs and multidisciplinary heart failure (MDS-HF) clinic interventions reduced all-cause readmission (high SOE). Home-visiting programs reduced HF-specific readmission and the composite end point (moderate SOE). Structured telephone support (STS) interventions reduced HF-specific readmission (high SOE) but not all-cause readmissions (moderate SOE). Home-visiting programs, MDS-HF clinics, and STS interventions produced a mortality benefit. Neither telemonitoring nor primarily educational interventions reduced readmission or mortality rates.
  
  
  CONCLUSIONS
  Few trials reported 30-day readmission rates. Usual care was heterogeneous and sometimes not adequately described.
  
  
  CONCLUSIONS
  Home-visiting programs and MDS-HF clinics reduced all-cause readmission and mortality; STS reduced HF-specific readmission and mortality. These interventions should receive the greatest consideration by systems or providers seeking to implement transitional care interventions for persons with HF.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Feltner
authors.forename: Christine D
authors.initials: CD
authors.lastname: Jones
authors.forename: Crystal W
authors.initials: CW
authors.lastname: Cené
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Zheng
authors.forename: Carla A
authors.initials: CA
authors.lastname: Sueta
authors.forename: Emmanuel J L
authors.initials: EJ
authors.lastname: Coker-Schwimmer
authors.forename: Marina
authors.initials: M
authors.lastname: Arvanitis
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Lohr
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Middleton
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Jonas
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D003266:Continuity of Patient Care; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006699:Home Care Services; D006801:Humans; D010359:Patient Readmission; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine