Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis.
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 o...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2015-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4460137?pdf=render |
| _version_ | 1811192574497521664 |
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| author | Amro Qaddoura Payam Yazdan-Ashoori Conrad Kabali Lehana Thabane R Brian Haynes Stuart J Connolly Harriette Gillian Christine Van Spall |
| author_facet | Amro Qaddoura Payam Yazdan-Ashoori Conrad Kabali Lehana Thabane R Brian Haynes Stuart J Connolly Harriette Gillian Christine Van Spall |
| author_sort | Amro Qaddoura |
| collection | DOAJ |
| description | 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.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.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. |
| first_indexed | 2024-04-11T23:55:59Z |
| format | Article |
| id | doaj.art-1e8ae4e8b6bb4e9e8c0d071f3503bc74 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-11T23:55:59Z |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-1e8ae4e8b6bb4e9e8c0d071f3503bc742022-12-22T03:56:22ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-01106e012928210.1371/journal.pone.0129282Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis.Amro QaddouraPayam Yazdan-AshooriConrad KabaliLehana ThabaneR Brian HaynesStuart J ConnollyHarriette Gillian Christine Van SpallHeart 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.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.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.http://europepmc.org/articles/PMC4460137?pdf=render |
| spellingShingle | Amro Qaddoura Payam Yazdan-Ashoori Conrad Kabali Lehana Thabane R Brian Haynes Stuart J Connolly Harriette Gillian Christine Van Spall Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. PLoS ONE |
| title | Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. |
| title_full | Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. |
| title_fullStr | Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. |
| title_full_unstemmed | Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. |
| title_short | Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. |
| title_sort | efficacy of hospital at home in patients with heart failure a systematic review and meta analysis |
| url | http://europepmc.org/articles/PMC4460137?pdf=render |
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