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

Author

Listed:
  • 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.

Suggested Citation

  • Amro Qaddoura & Payam Yazdan-Ashoori & Conrad Kabali & Lehana Thabane & R Brian Haynes & Stuart J Connolly & Harriette Gillian Christine Van Spall, 2015. "Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-15, June.
    • Handle: RePEc:plo:pone00:0129282
    DOI: 10.1371/journal.pone.0129282
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Viechtbauer, Wolfgang, 2010. "Conducting Meta-Analyses in R with the metafor Package," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 36(i03).
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    1. Minlu Li & Yuan Li & Qingtong Meng & Yinyin Li & Xiaomeng Tian & Ruixia Liu & Jinbo Fang, 2021. "Effects of nurse-led transitional care interventions for patients with heart failure on healthcare utilization: A meta-analysis of randomized controlled trials," PLOS ONE, Public Library of Science, vol. 16(12), pages 1-16, December.
    2. Cintia Curioni & Ana Carolina Silva & Jorginete Damião & Andrea Castro & Miguel Huang & Taianah Barroso & Daniel Araujo & Renata Guerra, 2023. "The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review," IJERPH, MDPI, vol. 20(4), pages 1-21, February.

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