title: What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review.
abstract: 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.
  
  
  
  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 1stJanuary 2008 to 4thAugust 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia. andrea.driscoll@deakin.edu.au.
authors.forename: Andrea
authors.initials: A
authors.lastname: Driscoll
authors.affiliation: Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Meagher
authors.affiliation: Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia.
authors.forename: Rhoda
authors.initials: R
authors.lastname: Kennedy
authors.affiliation: Heart Foundation (Victoria), Level 12, 500 Collins st, Melbourne, 3000, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Hay
authors.affiliation: School of Rural Health, Monash University, Bendigo, Victoria, Australia.
authors.forename: Jayant
authors.initials: J
authors.lastname: Banerji
authors.affiliation: Monash Health, Clayton, Melbourne, Australia.
authors.forename: Donald
authors.initials: D
authors.lastname: Campbell
authors.affiliation: Cardiology Department, Western Health, Gordon Street, Footscray, 3011, Melbourne, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cox
authors.affiliation: Monash Health, Monash Health Community, Dandenong, Melbourne, Australia.
authors.forename: Debra
authors.initials: D
authors.lastname: Gascard
authors.affiliation: Department of Cardiology, University of Melbourne and Austin Health, Burgundy St Heidelberg, 3081, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Hare
authors.affiliation: Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Page
authors.affiliation: Cardiology Department, Bendigo Health, Victoria, Australia.
authors.forename: Voltaire
authors.initials: V
authors.lastname: Nadurata
authors.affiliation: St Vincent's Hospital, Victoria parade, Melbourne, Australia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Sanders
authors.affiliation: Heart Foundation (Victoria), Level 12, 500 Collins st, Melbourne, 3000, Australia.
authors.forename: Harry
authors.initials: H
authors.lastname: Patsamanis
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D014943:Global Health; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D058996:Quality Improvement; D015996:Survival Rate / Q000639:trends
keywords: Heart failure; Hospital readmissions; Hospitalisations; Primary care; Systematic review; Systems of care; Transitional care; Workforce