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A Systematic Review and Meta-analysis of Studies Comparing Readmission Rates and Mortality Rates in Patients With Heart Failure
Femida H. Gwadry-Sridhar, PhD(C);
Virginia Flintoft, MSc;
Douglas S. Lee, MD;
Hui Lee, MD ;
Gordon H. Guyatt, MD
Arch Intern Med. 2004;164:2315-2320.
Background Heart failure is the leading cause of hospitalization and readmission in many hospitals worldwide. We performed a meta-analysis to evaluate the effectiveness of multidisciplinary heart failure management programs on hospital admission rates.
Methods We identified studies through an electronic search and mortality using 8 distinct methods. Eligible studies met the following criteria: (1) randomized controlled clinical trials of adult inpatients hospitalized for heart failure enrolled either at the time of discharge or within 1 week after discharge; (2) heart failure–specific patient education intervention coupled with a postdischarge follow-up assessment; and (3) unplanned readmission reported. Four reviewers independently assessed each study for eligibility and quality, achieving a weighted  of 0.73 for eligibility and 0.77 for quality. For each study we calculated the relative risk for readmissions and mortality for patients receiving enhanced education relative to patients receiving usual care.
Results A total of 529 citation titles were identified, of which 8 randomized trials proved eligible. The pooled relative risk for hospital readmission rates using a random-effects model was 0.79 (95% confidence interval, 0.68-0.91; P<.001; heterogeneity P = .25). There was no apparent effect on mortality (relative risk, 0.98; 95% confidence interval, 0.72-1.34; P = .90; heterogeneity P = .20). Data were insufficient to meaningfully pool intervention effects on quality of life or compliance.
Conclusion This systematic review suggests that specific heart failure–targeted interventions significantly decrease hospital readmissions but do not affect mortality rates.
Author Affiliations: Division of Critical Care, Department of Medicine, University of Western Ontario, and London Health Sciences Centre, London, Ontario (Dr Gwadry-Sridhar); Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario (Ms Flintoft); National Heart, Lung, and Blood Institute, Framingham, Mass (Dr D. S. Lee); and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Drs Gwadry-Sridhar, H. Lee, and Guyatt).
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