Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis.
<h4>Background</h4>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 med...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2015-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0129282 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849470359463526400 |
|---|---|
| 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 | <h4>Background</h4>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.<h4>Methods and results</h4>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.<h4>Conclusions</h4>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. |
| format | Article |
| id | doaj-art-1e8ae4e8b6bb4e9e8c0d071f3503bc74 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-1e8ae4e8b6bb4e9e8c0d071f3503bc742025-08-20T03:25:11ZengPublic 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 Spall<h4>Background</h4>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.<h4>Methods and results</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0129282 |
| 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 | https://doi.org/10.1371/journal.pone.0129282 |
| work_keys_str_mv | AT amroqaddoura efficacyofhospitalathomeinpatientswithheartfailureasystematicreviewandmetaanalysis AT payamyazdanashoori efficacyofhospitalathomeinpatientswithheartfailureasystematicreviewandmetaanalysis AT conradkabali efficacyofhospitalathomeinpatientswithheartfailureasystematicreviewandmetaanalysis AT lehanathabane efficacyofhospitalathomeinpatientswithheartfailureasystematicreviewandmetaanalysis AT rbrianhaynes efficacyofhospitalathomeinpatientswithheartfailureasystematicreviewandmetaanalysis AT stuartjconnolly efficacyofhospitalathomeinpatientswithheartfailureasystematicreviewandmetaanalysis AT harriettegillianchristinevanspall efficacyofhospitalathomeinpatientswithheartfailureasystematicreviewandmetaanalysis |