Evidence map›Paper›PMID 34273282›Full record

ArticleThe American journal of medicine2021

Cardiac Transitional Care Effectiveness: Does Overall Comorbidity Burden Matter?

Joshua Garfein, George Cholack, Rachel Krallman, Delaney Feldeisen, Daniel Montgomery, Eva Kline-Rogers, Kim Eagle, Melvyn Rubenfire, Sherry Bumpus

Abstract read
In one paragraph

Article in The American journal of medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Joshua GarfeinMichigan Medicine, Ann Arbor.
George CholackMichigan Medicine, Ann Arbor; Oakland University William Beaumont School of Medicine, Rochester, Mich.
Rachel KrallmanMichigan Medicine, Ann Arbor.
Delaney FeldeisenMichigan Medicine, Ann Arbor.
Daniel MontgomeryMichigan Medicine, Ann Arbor.
Eva Kline-RogersMichigan Medicine, Ann Arbor.
Kim EagleMichigan Medicine, Ann Arbor.
Melvyn RubenfireMichigan Medicine, Ann Arbor.
Sherry BumpusMichigan Medicine, Ann Arbor; Eastern Michigan University, School of Nursing, Ypsilanti. Electronic address: sbumpus2@emich.edu.

Funding

NRSA Training CoreTL1TR002242 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HOLINSTAT, MICHAEL ALLAN · 2017 to 2021
$2.8M
NCATS NIH HHS TL1 TR002242
6 · The paper itself

Abstract

backgroundCardiovascular disease is the most common cause of mortality and hospitalization in the United States. Transitional care initiatives can improve outcomes for cardiac patients, but it is unclear whether patients with different baseline comorbidity burden benefit equally. We evaluated the effectiveness of the Bridging the Discharge Gap Effectively (BRIDGE) program, a nurse-practitioner-led transitional care clinic, in mitigating adverse clinical outcomes in cardiac patients with varying Charlson comorbidity index (CCI).

methodsWe studied patients referred to BRIDGE between 2008 and 2017 postdischarge for a cardiac condition. Using proportional hazards regression models, we evaluated associations between attendance at BRIDGE and hospital readmission, emergency department (ED) visit, and a composite outcome consisting of readmission, ED visit, or mortality, and assessed interaction between BRIDGE attendance and CCI.

resultsOf 4559 patients, 3256 (71.4%) attended BRIDGE. In patients with low CCI, attendance at BRIDGE was inversely associated with hospital readmission (adjusted hazard ratio = 0.82, 95% confidence interval [CI]: 0.69, 0.97, P = .02) and the composite endpoint (adjusted hazard ratio = 0.84, 95% CI: 0.72, 0.98, P = .02). Associations of BRIDGE attendance with both readmission and ED visit were significantly weaker in patients with high CCI (adjusted P, interaction = .007 and .03, respectively). Overall, BRIDGE attendance was associated with an 11% lower hazard of developing the composite endpoint (95% CI: 2%, 19%, P = .01).

conclusionsAttendance at a transitional care clinic is inversely associated with risk of readmission and a composite endpoint in cardiac patients with low CCI. Future research should investigate modified transitional care programs in patients with varying comorbidity burden.

Indexed as

Hospital to Home TransitionMortalityTransitional CareAcute Coronary SyndromeAdultAgedAged, 80 and overAtrial FibrillationCerebrovascular DisordersComorbidityDementiaDiabetes MellitusEmergency Service, HospitalHeart DiseasesHeart FailureHumansAll-cause mortalityCharlson comorbidity indexMidlevel providersReadmissionsTransitional care

Identifiers

PMID34273282
PMCPMC8688268

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.