30-day readmission of patients with acute heart failure: a meta-analysis of real-world studies <i>vs.</i> randomized controlled trials_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Xuecheng ^1,2 , LIU Yan ¹ , ZHANG Jingjing ^1,2 , CHEN Ying ^1,2 , DAI Hengheng ^1,2 , WAN Siqi ^1,2 , GUAN Zhiyue ^1,2 , HU Mingzhi ^1,2 ,  SHANG Hongcai ¹

1. Chinese Academy of Medical Sciences and Peking Union Medical Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P.R.China;
2. Beijing University of Chinese Medicine, Beijing 100029, P.R.China;

Corresponding author：

SHANG Hongcai, Email: shanghongcai@126.com

Keywords：

Real-world study; Randomized controlled trial; Acute heart failure; Readmission rate; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.202104094

Video：

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Objective To systematically review the difference in 30-day readmission rates among acute heart failure patients between real-world studies vs. randomized controlled trials (RCTs). Methods PubMed, EMbase, The Cochrane Library, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect clinical studies on 30-day readmission rates in patients with acute heart failure from inception to April 12^th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software. Results A total of 33 real-world studies and 11 RCTs involving 106 722 subjects were included. The results of meta-analysis showed that the 30-day heart failure-related readmission rates in the real-world studies and RCTs were 10.8% (95%CI 9.3% to 12.3%) and 6.9% (95%CI 5.3% to 8.4%), respectively. The 30-day all-cause readmission rates in real-world studies and randomized controlled studies were 18.6% (95%CI 15.7% to 21.4%) and 14.2% (95%CI 12.0% to 16.3%), respectively. There were statistically significant differences between two kinds of studies (P<0.05). Conclusions Current evidence suggests that the 30-day heart failure-related and all-cause readmission rates in patients of acute heart failure in real-world studies are significantly higher than those in patients of RCTs. Due to the limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.

Citation： ZHANG Xuecheng, LIU Yan, ZHANG Jingjing, CHEN Ying, DAI Hengheng, WAN Siqi, GUAN Zhiyue, HU Mingzhi, SHANG Hongcai. 30-day readmission of patients with acute heart failure: a meta-analysis of real-world studies vs. randomized controlled trials. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1203-1210. doi: 10.7507/1672-2531.202104094 Copy

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2.	Bueno H, Ross JS, Wang Y, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA, 2010, 303(21): 2141-2147.
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1. 王华, 梁延春. 中国心力衰竭诊断和治疗指南 2018. 中华心血管病杂志, 2018, 46(10): 760-789.
2. Bueno H, Ross JS, Wang Y, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA, 2010, 303(21): 2141-2147.
3. 宣建伟, 朱水清, 王韶屏, 等. 我国一线城市心力衰竭患者住院费用调查及其影响因素分析. 中国医疗保险, 2017, (12): 52-56.
4. 国家心血管病医疗质量控制中心专家委员会心力衰竭专家工作组. 2020 中国心力衰竭医疗质量控制报告. 中国循环杂志, 2021, 36(3): 221-238.
5. Dharmarajan K, Hsieh AF, Lin Z, et al. Hospital readmission performance and patterns of readmission: retrospective cohort study of medicare admissions. BMJ, 2013, 347: f6571.
6. Lim NK, Lee SE, Lee HY, et al. Risk prediction for 30-day heart failure-specific readmission or death after discharge: data from the Korean acute heart failure (KorAHF) registry. J Cardiol, 2019, 73(2): 108-113.
7. Bensimhon D, Alali SA, Curran L, et al. The use of the reds noninvasive lung fluid monitoring system to assess readiness for discharge in patients hospitalized with acute heart failure: A pilot study. Heart Lung, 2021, 50(1): 59-64.
8. Woodruff AE, Kelley AM, Hempel CA, et al. Discharge diuretic dose and 30-day readmission rate in acute decompensated heart failure. Ann Pharmacother, 2016, 50(6): 437-445.
9. 石舒原, 赵厚宇, 周庆欣, 等. 真实世界证据与随机对照试验: RCT DUPLICATE 项目方法学介绍. 药物流行病学杂志, 2020, 29(3): 198-205.
10. Peppercorn JM, Weeks JC, Cook EF, et al. Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review. Lancet, 2004, 363(9405): 263-270.
11. Hassett MJ, O'Malley AJ, Pakes JR, et al. Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancer. J Natl Cancer Inst, 2006, 98(16): 1108-1117.
12. Çağlayan Ç, Goldstein JS, Ayer T, et al. A population-based multistate model for diffuse large B-cell lymphoma-specific mortality in older patients. Cancer, 2019, 125(11): 1837-1847.
13. Prince RM, Atenafu EG, Krzyzanowska MK. Hospitalizations during systemic therapy for metastatic lung cancer: a systematic review of real world vs clinical trial outcomes. JAMA Oncol, 2015, 1(9): 1333-1339.
14. 田磊, 岳彩宾, 管欣, 等. 真实世界研究与随机对照试验在临床实践及卫生决策中应用的比较. 中国医院药学杂志, 2019, 39(3): 274-277.
15. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
16. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
17. 刘曼, 陈文松, 刘玉秀, 等. 单组率研究含零事件的 Meta 分析方法. 中国循证医学杂志, 2020, 20(10): 1226-1233.
18. Bartone C, Saghir S, Menon SG, et al. Comparison of ultrafiltration, nesiritide, and usual care in acute decompensated heart failure. Congest Heart Fail, 2008, 14(6): 298-301.
19. Basoor A, Doshi NC, Cotant JF, et al. Decreased readmissions and improved quality of care with the use of an inexpensive checklist in heart failure. Congest Heart Fail, 2013, 19(4): 200-206.
20. Chen L, Ionescu-Ittu R, Romdhani H, et al. Disease management and outcomes in patients hospitalized for acute heart failure in Japan. Cardiol Ther, 2021, 10(1): 211-228.
21. De Vecchis R, Di Maio M, Di Biase G, et al. Effects of hyponatremia normalization on the short-term mortality and rehospitalizations in patients with recent acute decompensated heart failure: a retrospective study. J Clin Med, 2016, 5(10): 92.
22. Di Tano G, De Maria R, Gonzini L, et al. The 30-day metric in acute heart failure revisited: data from IN-HF outcome, an Italian nationwide cardiology registry. Eur J Heart Fail, 2015, 17(10): 1032-1041.
23. Dunlay SM, Griffin JM, Redfield MM, et al. Patient activation in acute decompensated heart failure. J Cardiovasc Nurs, 2017, 32(6): 560-567.
24. Freda BJ, Knee AB, Braden GL, et al. Effect of transient and sustained acute kidney injury on readmissions in acute decompensated heart failure. Am J Cardiol, 2017, 119(11): 1809-1814.
25. Fudim M, Sayeed S, Xu H, et al. Representativeness of the PIONEER-HF clinical trial population in patients hospitalized with heart failure and reduced ejection fraction. Circ Heart Fail, 2020, 13(4): e006645.
26. Gunton JE, Nandal S, Jones J, et al. Validation of the "doorbell test": a novel functional test of frailty and clinical status after acute decompensated heart failure. Heart Lung Circ, 2020, 29(7): 1054-1062.
27. He W, Jia J, Chen J, et al. Comparison of prognostic value of red cell distribution width and NT-proBNP for short-term clinical outcomes in acute heart failure patients. Int Heart J, 2014, 55(1): 58-64.
28. Kitakata H, Kohno T, Kohsaka S, et al. Prognostic implications of early and midrange readmissions after acute heart failure hospitalizations: a report from a Japanese multicenter registry. J Am Heart Assoc, 2020, 9(10): e014949.
29. Laliberte B, Reed BN, Devabhakthuni S, et al. Observation of patients transitioned to an oral loop diuretic before discharge and risk of readmission for acute decompensated heart failure. J Card Fail, 2017, 23(10): 746-752.
30. Lee SE, Lee HY, Cho HJ, et al. Clinical characteristics and outcome of acute heart failure in Korea: results from the Korean acute heart failure registry (KorAHF). Korean Circ J, 2017, 47(3): 341-353.
31. Miñana G, Bosch MJ, Núñez E, et al. Length of stay and risk of very early readmission in acute heart failure. Eur J Intern Med, 2017, 42: 61-66.
32. Miró Ò, Gil V, Xipell C, et al. IMPROV-ED study: outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards. Clin Res Cardiol, 2017, 106(5): 369-378.
33. Nael J, Ruggiu M, Bailleul C, et al. Impact of hyperoxia on patients hospitalized in an intensive care unit for acute heart failure. Arch Cardiovasc Dis, 2019, 112(12): 748-753.
34. Newton PJ, Si S, Reid CM, et al. Survival after an acute heart failure admission. Twelve-month outcomes from the NSW HF snapshot study. Heart Lung Circ, 2020, 29(7): 1032-1038.
35. Núñez J, Bonanad C, Navarro JP, et al. Differential effect of glycosylated hemoglobin value and antidiabetic treatment on the risk of 30-day readmission following a hospitalization for acute heart failure. Rev Esp Cardiol (Engl Ed), 2015, 68(10): 852-860.
36. Núñez J, Comín-Colet J, Miñana G, et al. Iron deficiency and risk of early readmission following a hospitalization for acute heart failure. Eur J Heart Fail, 2016, 18(7): 798-802.
37. Oehler A, Kent K, Davis J. Assessment of discharge readiness and readmission risk in patients with acute decompensated heart failure. Am J Cardiol, 2018, 122(12): 2086-2094.
38. Ogunneye O, Rothberg MB, Friderici J, et al. The association between skilled nursing facility care quality and 30-day readmission rates after hospitalization for heart failure. Am J Med Qual, 2015, 30(3): 205-213.
39. Okuhara Y, Hirotani S, Ando T, et al. Comparison of salt with low-dose furosemide and carperitide for treating acute decompensated heart failure: a single-center retrospective cohort study. Heart Vessels, 2017, 32(4): 419-427.
40. Rahhal A, Saad MO, Tawengi K, et al. Torsemide versus furosemide after acute decompensated heart failure: a retrospective observational study. BMC Cardiovasc Disord, 2019, 19(1): 127.
41. Schrager J, Wheatley M, Georgiopoulou V, et al. Favorable bed utilization and readmission rates for emergency department observation unit heart failure patients. Acad Emerg Med, 2013, 20(6): 554-561.
42. Selim AM, Mazurek JA, Iqbal M, et al. Mortality and readmission rates in patients hospitalized for acute decompensated heart failure: a comparison between cardiology and general-medicine service outcomes in an underserved population. Clin Cardiol, 2015, 38(3): 131-138.
43. Sudharshan S, Novak E, Hock K, et al. Use of Biomarkers to predict readmission for congestive heart failure. Am J Cardiol, 2017, 119(3): 445-451.
44. Tabit CE, Coplan MJ, Spencer KT, et al. Cardiology consultation in the emergency department reduces re-hospitalizations for low-socioeconomic patients with acute decompensated heart failure. Am J Med, 2017, 130(9): 1112-1117.
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