Active follow-up with telephone help can reduce deaths in chronic heart failure patients

September 11, 2012

Chronic heart failure (CHF) patients are less likely to have died a year after discharge if they are involved in a programme of active follow-up once they have returned home than patients given standard care, according to a new Cochrane Systematic Review. These patients were also less likely to need to go back into hospital in the six months that follow discharge.

CHF is a serious condition, mainly affecting elderly people. It is becoming increasingly common as the population ages, and carries high risks of emergency and death. It affects around three to 20 per 1,000 of the general population, with figures rising to 10% of people aged between 80 and 89. In the UK, CHF consumes almost 2% of the 's budget, most of the cost being linked to .

A team of six researchers based in the UK and Australia examined 25 clinical trials with nearly 6,000 patients. The trials tested different methods of organising the care of CHF patients after they leave hospital. The researchers identified three types of care: 1) case-management interventions, where patients were intensively monitored by telephone calls and , usually by a specialist nurse; 2) clinic interventions involving follow up in a specialist CHF clinic; 3) multidisciplinary interventions, in which a team of professionals bridged the gap between hospital admission and living back at home.

Patients who received case-management intervention had less 'all cause' mortality a year after discharge than those receiving usual care, although there were no differences at six months after discharge.

"We weren't able to identify the optimal components of case-management interventions, but telephone follow up by a specialist nurse was a very common element," says research spokesperson Stephanie Taylor.

Only two studies looked at multidisciplinary follow-up and in these there were fewer deaths from any cause than in groups of given usual care. More trials would be needed to confirm this finding. Follow-up in a clinic, however, was assessed in six trials, and here there was no real difference in all-cause mortality and readmission rates compared with people receiving usual care.

Given the number of people who have CHF, Taylor and her colleagues believe that there is a need for research that deliberately compares different approaches to follow up, in particular comparing interventions that last for only a few weeks after discharge, with ones that span much longer periods. She also thinks that trials should look carefully at the costs and cost-effectiveness of each approach.

Explore further: Study identifies the most effective methods for reducing unplanned hospital admissions

More information: Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M. Clinical service organisation for heart failure. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD002752. DOI: 10.1002/14651858.CD002752.pub3

Related Stories

Study identifies the most effective methods for reducing unplanned hospital admissions

July 11, 2012
Unplanned admissions make up approximately 40 per cent of hospital admissions in England and can increase problems for health services as they are costly, disruptive, and lengthen waiting lists. New research, published today ...

Studies evaluate programs to transition care of patients after hospital discharge

July 25, 2011
Programs designed to help transition care for hospitalized older patients to outside healthcare clinicians and settings are associated with reduced rates of hospital readmissions, according to two reports in the July 25 issue ...

Uninsured trauma patients are more likely to use the ED for follow-up care

August 25, 2011
Providing access to an outpatient clinic isn't enough to keep some trauma patients who have been discharged from the hospital from returning to the emergency department (ED) for follow-up care, even for such minor needs as ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.