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

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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.

Related collections

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Author and article information

Contributors

Pasquale Abete: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 8 June 2015

Publication date Collection: 2015

Volume: 10

Issue: 6

Electronic Location Identifier: e0129282

Affiliations

[1 ]Department of Medicine, Queen’s University, Kingston, Ontario, Canada

[2 ]Department of Medicine, McMaster University, Hamilton, Ontario, Canada

[3 ]Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada

[4 ]Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

[5 ]Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada

University of Naples Federico II, ITALY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: HV AQ PYA. Performed the experiments: AQ PYA HV. Analyzed the data: AQ PYA CK HV LT. Contributed reagents/materials/analysis tools: HV CK. Wrote the paper: AQ PYA CK HV RBH SJC.

* E-mail: harriette.vanspall@ 123456phri.ca

Article

Publisher ID: PONE-D-15-01172

DOI: 10.1371/journal.pone.0129282

PMC ID: 4460137

PubMed ID: 26052944

SO-VID: 33edc522-cda9-4982-b452-3494ab3b2a13

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 9 January 2015

Date accepted : 6 May 2015

Page count

Figures: 4, Tables: 2, Pages: 15

Funding

This work was supported by the EJ Moran Campbell Award. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability All relevant data are within the paper and its Supporting Information files.

ScienceOpen disciplines: Uncategorized

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