Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Amro Qaddoura, Payam Yazdan-Ashoori, Conrad Kabali, Lehana Thabane, R Brian Haynes, Stuart J Connolly, Harriette Gillian Christine Van Spall, Amro Qaddoura, Payam Yazdan-Ashoori, Conrad Kabali, Lehana Thabane, R Brian Haynes, Stuart J Connolly, Harriette Gillian Christine Van Spall

Abstract

Background: Heart failure (HF) is the commonest cause of hospitalization in older adults. Compared to routine hospitalization (RH), hospital at home (HaH)--substitutive hospital-level care in the patient's home--improves outcomes and reduces costs in patients with general medical conditions. The efficacy of HaH in HF is unknown.

Methods and results: We searched MEDLINE, Embase, CINAHL, and CENTRAL, for publications from January 1990 to October 2014. We included prospective studies comparing substitutive models of hospitalization to RH in HF. At least 2 reviewers independently selected studies, abstracted data, and assessed quality. We meta-analyzed results from 3 RCTs (n = 203) and narratively synthesized results from 3 observational studies (n = 329). Study quality was modest. In RCTs, HaH increased time to first readmission (mean difference (MD) 14.13 days [95% CI 10.36 to 17.91]), and improved health-related quality of life (HrQOL) at both, 6 months (standardized MD (SMD) -0.31 [-0.45 to -0.18]) and 12 months (SMD -0.17 [-0.31 to -0.02]). In RCTs, HaH demonstrated a trend to decreased readmissions (risk ratio (RR) 0.68 [0.42 to 1.09]), and had no effect on all-cause mortality (RR 0.94 [0.67 to 1.32]). HaH decreased costs of index hospitalization in all RCTs. HaH reduced readmissions and emergency department visits per patient in all 3 observational studies.

Conclusions: In the context of a limited number of modest-quality studies, HaH appears to increase time to readmission, reduce index costs, and improve HrQOL among patients requiring hospital-level care for HF. Larger RCTs are necessary to assess the effect of HaH on readmissions, mortality, and long-term costs.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Summary of evidence search and…
Fig 1. Summary of evidence search and selection.
Fig 2. Hospital readmissions and all-cause mortality…
Fig 2. Hospital readmissions and all-cause mortality for HaH compared with inpatients in randomized controlled trials.
Fig 3. Hospital readmissions and emergency department…
Fig 3. Hospital readmissions and emergency department visits per patient in substitutive versus inpatients in observational studies.
Fig 4. Health-related quality of life for…
Fig 4. Health-related quality of life for HaH compared with inpatients at 6- and 12-month follow-up in randomized controlled trials.

References

    1. Nieminen MS, Harjola VP. Definition and epidemiology of acute heart failure syndromes. Am J Cardiol. 2005;96:5G–10G.
    1. Fang J, Mensah GA, Croft JB, Keenan NL. Heart failure-related hospitalization in the U.S., 1979 to 2004. J Am Coll Cardiol. 2008;52:428–34. 10.1016/j.jacc.2008.03.061
    1. Rodriguez-Artalejo F, Guallar-Castillon P, Pascual CR, Otero CM, Montes AO, Garcia AN, et al. Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Arch Intern Med. 2005;165:1274–9.
    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245. 10.1161/CIR.0b013e31828124ad
    1. Abete P, Testa G, Della-Morte D, Gargiulo G, Galizia G, de Santis D, et al. Treatment for chronic heart failure in the elderly: current practice and problems. Heart Fail Rev. 2013;18:529–51. 10.1007/s10741-012-9363-6
    1. Greene SJ, Fonarow GC, Vaduganathan M, Khan SS, Butler J, Gheorghiade M. The vulnerable phase after hospitalization for heart failure. Nat Rev Cardiol. 2015;12:220–9. 10.1038/nrcardio.2015.14
    1. Leff B, Burton L, Mader SL, Naughton B, Burl J, Inouye SK, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143:798–808.
    1. Caplan GA, Coconis J, Woods J. Effect of hospital in the home treatment on physical and cognitive function: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60:1035–8.
    1. Leff B, Montalto M. Hospital at home: Potential in geriatric healthcare and future challenges to dissemination. Aging Health. 2006;2:701–3.
    1. Leff B, Burton L, Mader SL, Naughton B, Burl J, Koehn D, et al. Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care. J Am Geriatr Soc. 2008;56:117–23.
    1. Leff B, Burton L, Mader SL, Naughton B, Burl J, Greenough WB, et al. Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care. J Am Geriatr Soc. 2009;57:273–8. 10.1111/j.1532-5415.2008.02103.x
    1. Stessman J, Ginsberg G, Hammerman-Rozenberg R, Friedman R, Ronen D, Israeli A, et al. Decreased hospital utilization by older adults attributable to a home hospitalization program. J Am Geriatr Soc. 1996;44:591–8.
    1. Shepperd S, Doll H, Broad J, Gladman J, Iliffe S, Langhorne P, et al. Early discharge hospital at home. Cochrane Database Syst Rev. 2009;(1):CD000356 10.1002/14651858.CD000356.pub3
    1. Shepperd S, Doll H, Angus RM, Clarke MJ, Iliffe S, Kalra L, et al. Admission avoidance hospital at home. Cochrane Database Syst Rev. 2008;(4):CD007491 10.1002/14651858.CD007491
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.
    1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.
    1. Wolochow M, Ham RJ. The geriatric day hospital: a Canadian experience. Can Fam Physician. 1986;32:2625–9.
    1. Higgins JPT, Green S, editors. Cochrane Handbook For Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. 2008. The Cochrane Collaboration, 2011. Available: .
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
    1. Brockwell SE, Gordon IR. A comparison of statistical methods for meta-analysis. Stat Med. 2001;20:825–40.
    1. Cornell JE, Mulrow CD, Localio R, Stack CB, Meibohm AR, Guallar E, et al. Random-Effects Meta-analysis of Inconsistent Effects: A Time for Change. Ann Intern Med. 2014;160:267–70.
    1. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48.
    1. Bechich S, Sort Granja D, Arroyo Mateo X, Delas Amat J, Rosell Abaurrea F. Effect of home hospitalization in the reduction of traditional hospitalization and frequency of emergencies in heart failure. Rev Clin Esp. 2000;200:310–4.
    1. de Zuazu HMR, de los Cobos JR, Basurto EA, Ruiz JMC, Borau FA, Eraso PL. Treatment of congestive heart failure in the setting of hospital at home. Study of 158 patients. Med Clin. 2003;120:405–7.
    1. Mendoza H, Martin MJ, Garcia A, Aros F, Aizpuru F, Regalado De Los Cobos J, et al. 'Hospital at home' care model as an effective alternative in the management of decompensated chronic heart failure. Eur J Heart Fail. 2009;11:1208–13. 10.1093/eurjhf/hfp143
    1. Patel H, Shafazand M, Ekman I, Hojgard S, Swedberg K, Schaufelberger M. Home care as an option in worsening chronic heart failure—a pilot study to evaluate feasibility, quality adjusted life years and cost-effectiveness. Eur J Heart Fail. 2008;10:675–81. 10.1016/j.ejheart.2008.05.012
    1. Roig E, Perez-Villa F, Cuppoletti A, Castillo M, Hernandez N, Morales M, et al. Specialized care program for end-stage heart failure patients. Initial experience in a heart failure unit. Rev Esp Cardiol. 2006;59:109–16.
    1. Tibaldi V, Isaia G, Scarafiotti C, Gariglio F, Zanocchi M, Bo M, et al. Hospital at home for elderly patients with acute decompensation of chronic heart failure: a prospective randomized controlled trial. Arch Intern Med. 2009;169:1569–75. 10.1001/archinternmed.2009.267
    1. García-Soleto A, Parraza-Diez N, Aizpuru-Barandiaran F, Aros-Borau F, de Zuazu HMR, Martin-Gudino MJ, et al. Comparative study of quality of life after hospital-at-home or in-patient admission for acute decompensation of chronic heart failure. World J Cardiovasc Dis. 2013;3:174–81.
    1. Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci. 1999;54:M521–6.
    1. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118:219–23.
    1. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. NEJM. 1991;324:370–6.
    1. Jeppesen E, Brurberg KG, Vist GE, Wedzicha JA, Wright JJ, Greenstone M, et al. Hospital at home for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;(5):CD003573 10.1002/14651858.CD003573.pub2
    1. Glasziou P, Meats E, Heneghan C, Shepperd S. What is missing from descriptions of treatment in trials and reviews? BMJ. 2008;336:1472–4. 10.1136/bmj.39590.732037.47
    1. Greenland S, Maclure M, Schlesselman JJ, Poole C, Morgenstern H. Standardized regression coefficients: a further critique and review of some alternatives. Epidemiology. 1991;2:387–92.
    1. Leff B, Montalto M. Home hospital-toward a tighter definition. J Am Geriatr Soc. 2004;52:2141

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner