title: Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis.
abstract: To compare the effectiveness of transitional care services in decreasing all-cause death and all-cause readmissions following hospitalization for heart failure (HF).
  
  
  
  We searched PubMed, Embase, CINAHL, and Cochrane Clinical Trials Register for randomized controlled trials (RCTs) published in 2000-2015 that tested the efficacy of transitional care services in patients hospitalized for HF, provided ≥1 month of follow-up, and reported all-cause mortality or all-cause readmissions. Our network meta-analysis included 53 RCTs (12 356 patients). Among services that significantly decreased all-cause mortality compared with usual care, nurse home visits were most effective [ranking P-score 0.6794; relative risk (RR) 0.78, 95% confidence intervals (CI) 0.62-0.98], followed by disease management clinics (DMCs) (ranking P-score 0.6368; RR 0.80, 95% CI 0.67-0.97). Among services that significantly decreased all-cause readmission, nurse home visits were most effective [ranking P-score 0.8365; incident rate ratio (IRR) 0.65, 95% CI 0.49-0.86], followed by nurse case management (NCM) (ranking P-score 0.6168; IRR 0.77, 95% CI 0.63-0.95), and DMCs (ranking P-score 0.5691; IRR 0.80, 95% CI 0.66-0.97). There was no significant difference in the comparative effectiveness of services that improved each outcome. Nurse home visits had the greatest pooled cost-savings (3810 USD, 95% CI 3682-3937), followed by NCM (3435 USD, 95% CI 3224-3645), and DMCs (245 USD, 95% CI -70 to 559). Telephone, telemonitoring, pharmacist, and education interventions did not significantly improve clinical outcomes.
  
  
  
  Nurse home visits and DMCs decrease all-cause mortality after hospitalization for HF. Along with NCM, they also reduce all-cause readmissions, with no significant difference in comparative effectiveness. These services reduce healthcare system costs to varying degrees.
authors.affiliation: Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, ON, Canada.|Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
authors.forename: Harriette G C
authors.initials: HGC
authors.lastname: Van Spall
authors.affiliation: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
authors.forename: Tahseen
authors.initials: T
authors.lastname: Rahman
authors.affiliation: MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Mytton
authors.affiliation: Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: Chinthanie
authors.initials: C
authors.lastname: Ramasundarahettige
authors.affiliation: Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: Quazi
authors.initials: Q
authors.lastname: Ibrahim
authors.affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Conrad
authors.initials: C
authors.lastname: Kabali
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Coppens
authors.affiliation: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Brian Haynes
authors.affiliation: Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Connolly
mesh_terms: D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011788:Quality of Life; D017216:Telemedicine; D000069341:Transitional Care / Q000592:standards*
keywords: Comparative effectiveness; Heart failure; Transitional care