Multidisciplinary Heart Failure Clinics Are Associated With Lower Heart Failure Hospitalization and Mortality: Systematic Review and Meta-analysis

被引:64
作者
Gandhi, Sumeet [1 ]
Mosleh, Wassim [2 ]
Sharma, Umesh C. [2 ]
Demers, Catherine [1 ]
Farkouh, Michael E. [3 ,4 ]
Schwalm, Jon-David [1 ]
机构
[1] McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Hamilton, ON, Canada
[2] SUNY Buffalo, Buffalo, NY USA
[3] Univ Toronto, Peter Munk Cardiac Ctr & Heart, Toronto, ON, Canada
[4] Univ Toronto, Stroke Richard Lewar Ctr, Toronto, ON, Canada
关键词
EXTENDED FOLLOW-UP; MANAGEMENT PROGRAM; TRANSITIONAL CARE; RANDOMIZED-TRIAL; ELDERLY-PATIENTS; OUTCOMES; IMPACT; COST; HOME; INTERVENTION;
D O I
10.1016/j.cjca.2017.05.011
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Heart failure (HF) clinics (HFCs) are an integral aspect of the strategy for community HF care. Methods: A systematic search was conducted to retrieve studies. We searched for candidate articles in the PubMed, EMBASE, and Cochrane databases from 1990 to January 2017. Results: We included 16 randomized controlled trials in the meta-analysis with 3999 patients. The HFC group had a lower incidence of the primary composite end point of HF hospitalization and all-cause mortality (odds ratio [OR], 0.58; P = 0.0003). The benefit was maintained when stratified according to non-nurse led HFCs (OR, 0.52; P = 0.003), clinics that followed-up patients >= 3 months (OR, 0.51; P = 0.0009), patients with mean ejection fraction <= 30% (OR, 0.39; P = 0.02), and ejection fraction > 30% (OR, 0.72; P = 0.02), and patients with recent hospitalization for HF (OR, 0.51; P = 0.0001). There was no benefit in patients who were seen in HFCs with limited follow-up <= 3 months (OR, 0.91; P = 0.69), patients with stable HF without recent hospitalization (OR, 0.95; P = 0.70), and studies published after 2008 (OR, 0.89; P = 0.31). Patients in the HFC group had lower HF hospitalization rates (OR, 0.68; P = 0.003), however, no significant difference in all-cause hospitalization (OR, 1.04; P = 0.33). There was lower all-cause mortality in the HFC group (OR, 0.71; P = 0.006). Conclusions: The results of our analysis show a benefit of HFC to reduce HF hospitalization, and all-cause mortality. This was a cumulative benefit of all randomized clinical trials that assessed the benefit of HFC, with additional analysis showing a greater benefit among patients with recent emergency room visit or hospitalization, and patients seen frequently in follow-up >= 3 months.
引用
收藏
页码:1237 / 1244
页数:8
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