Six RCTs involving 949 patients were included. The secondary outcomes were based on fewer than 6 studies. Two studies (288 participants) used more complex interventions, while 4 studies (661 participants) used less complex interventions.
The studies had a median Jadad score of 4 out of 5 (range: 3 to 4) for study quality.
There was no evidence of publication bias for the outcomes of hospital readmission or number of hospital days used. No results of the test for publication bias were reported for other outcomes.
Overall, the interventions did not affect hospital readmission rates in comparison with usual care. No effect on readmission rate was observed for any level of protocol complexity. Interventions that included discharge planning reduced HF readmissions (compared with usual care) to a greater extent than those that did not: RR 0.09 (95% CI: 0.10, 0.65) versus RR 0.65 (95% CI: 0.43, 1.00).
Interventions that incorporated discharge planning slightly reduced the number of hospital days used during follow-up (0.26 fewer days, 95% CI: 0.02, 0.49), whereas those that did not had no effect.
Overall, the interventions did not affect all-cause mortality in comparison with usual care. No effect on all-cause mortality was observed for any level of protocol complexity. There was also no effect of the interventions on the combined outcome of mortality and hospitalisation.
QOL improved for patients offered the intervention and usual care, but there was no difference in QOL between the two groups. The QOL data used in the review were incomplete.
Subgroup analyses.
There were no differences in the results for hospital readmission rates or number of hospital days used according to the patient's age or percentage LVEF. All-cause mortality was reduced by the intervention (compared with usual care) in studies with ACE inhibitor use of more than 75% (RR 0.59, 95% CI: 0.40, 0.86), but there was no effect of the intervention on all-cause mortality in those studies with suboptimal ACE inhibitor use.