TY - JOUR
T1 - Use of novel non-invasive techniques and biomarkers to guide outpatient management of fluid overload and reduce hospital readmission
T2 - systematic review and meta-analysis
AU - Zisis, Georgios
AU - Halabi, Amera
AU - Huynh, Quan
AU - Neil, Christopher
AU - Carrington, Melinda
AU - Marwick, Thomas H.
N1 - Funding Information:
This study was supported in part by a ‘Keeping Australians out of Hospital’ grant from the Medical Research Future Fund (1176629), Canberra, Australia, and a National Health and Medical Research Council (NHMRC) Partnership grant (1059738), Canberra, Australia. Q.H. is supported by an Early Career Fellowship, National Heart Foundation of Australia (NHFA), National Heart Foundation, Melbourne, Australia. M.C. is supported by an NHFA Future Leader Fellowship (100802).
Publisher Copyright:
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2021/10
Y1 - 2021/10
N2 - Aims: Fluid congestion is a leading cause of hospital admission, readmission, and mortality in heart failure (HF). We performed a systematic review and meta-analysis to determine the effectiveness of an advanced fluid management programme (AFMP). The AFMP was defined as an intervention providing tailored diuretic therapy guided by intravascular volume assessment, in hospitalized patients or after discharge. The AFMP group was compared with patients who received standard care treatment. The aim of this systematic review and meta-analysis was to determine the effectiveness of an AFMP in improving patient outcomes. Methods and results: A systematic review of randomized controlled trials, case–control studies, and crossover studies using the terms ‘heart failure’, ‘fluid management’, and ‘readmission’ was conducted in PubMed, CINAHL, and Scopus up until November 2020. Studies reporting the association of an AFMP on readmission and/or mortality were included in our meta-analyses. Risk of bias was assessed in non-randomized studies using the Newcastle–Ottawa Scale. From 232 retrieved studies, 12 were included in the data synthesis. The 6040 patients in the included studies had a mean age of 72 ± 4 years and mean left ventricular ejection fraction of 39 ± 8%, there were slightly more men (n = 3022) than women, and the follow-up period was a mean of 4.8 ± 3.1 months. Readmission data were available in 5362 patients; of these, 1629 were readmitted. Mortality data were available in 5787 patients; of these, 584 died. HF patients who had an AFMP in hospital and/or after discharge had lower odds of all-cause readmission (odds ratio—OR 0.64 [95% confidence interval—CI 0.44, 0.92], P = 0.02) with moderate heterogeneity (I2 = 46.5) and lower odds of all-cause mortality (OR 0.82 [95% CI 0.69, 0.98], P = 0.03) with low heterogeneity (I2 = 0). The use of an AFMP was equally effective in reducing readmission and mortality regardless of age and follow-up duration. Effective pre-discharge diuresis was associated with significantly lower readmission odds (OR 0.43 [95% CI 0.26, 0.71], P = 0.001) compared with a fluid management plan as part of post-discharge follow-up. Conclusions: An effective AFMP is associated with improving readmission and mortality in HF. Our results encourage attainment of optimal volume status at discharge and prescription of optimal diuretic dose. Ongoing support to maintain euvolaemia and effective collaboration between healthcare teams, along with effective patient education and engagement, may help to reduce adverse outcomes in HF patients.
AB - Aims: Fluid congestion is a leading cause of hospital admission, readmission, and mortality in heart failure (HF). We performed a systematic review and meta-analysis to determine the effectiveness of an advanced fluid management programme (AFMP). The AFMP was defined as an intervention providing tailored diuretic therapy guided by intravascular volume assessment, in hospitalized patients or after discharge. The AFMP group was compared with patients who received standard care treatment. The aim of this systematic review and meta-analysis was to determine the effectiveness of an AFMP in improving patient outcomes. Methods and results: A systematic review of randomized controlled trials, case–control studies, and crossover studies using the terms ‘heart failure’, ‘fluid management’, and ‘readmission’ was conducted in PubMed, CINAHL, and Scopus up until November 2020. Studies reporting the association of an AFMP on readmission and/or mortality were included in our meta-analyses. Risk of bias was assessed in non-randomized studies using the Newcastle–Ottawa Scale. From 232 retrieved studies, 12 were included in the data synthesis. The 6040 patients in the included studies had a mean age of 72 ± 4 years and mean left ventricular ejection fraction of 39 ± 8%, there were slightly more men (n = 3022) than women, and the follow-up period was a mean of 4.8 ± 3.1 months. Readmission data were available in 5362 patients; of these, 1629 were readmitted. Mortality data were available in 5787 patients; of these, 584 died. HF patients who had an AFMP in hospital and/or after discharge had lower odds of all-cause readmission (odds ratio—OR 0.64 [95% confidence interval—CI 0.44, 0.92], P = 0.02) with moderate heterogeneity (I2 = 46.5) and lower odds of all-cause mortality (OR 0.82 [95% CI 0.69, 0.98], P = 0.03) with low heterogeneity (I2 = 0). The use of an AFMP was equally effective in reducing readmission and mortality regardless of age and follow-up duration. Effective pre-discharge diuresis was associated with significantly lower readmission odds (OR 0.43 [95% CI 0.26, 0.71], P = 0.001) compared with a fluid management plan as part of post-discharge follow-up. Conclusions: An effective AFMP is associated with improving readmission and mortality in HF. Our results encourage attainment of optimal volume status at discharge and prescription of optimal diuretic dose. Ongoing support to maintain euvolaemia and effective collaboration between healthcare teams, along with effective patient education and engagement, may help to reduce adverse outcomes in HF patients.
KW - Adherence
KW - ADHF
KW - Decongestion
KW - Diuresis
KW - Fluid management
KW - Guided treatment
UR - http://www.scopus.com/inward/record.url?scp=85110995933&partnerID=8YFLogxK
U2 - 10.1002/ehf2.13510
DO - 10.1002/ehf2.13510
M3 - Article
C2 - 34296530
AN - SCOPUS:85110995933
SN - 2055-5822
VL - 8
SP - 4228
EP - 4242
JO - ESC Heart Failure
JF - ESC Heart Failure
IS - 5
ER -