Open Access Research article

Effects of care pathways on the in-hospital treatment of heart failure: a systematic review

Seval Kul1*, Antonella Barbieri2, Erika Milan3, Ilke Montag4, Kris Vanhaecht45 and Massimiliano Panella25

Author affiliations

1 Department of Biostatistics, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey

2 Department of Clinical and Experimental Medicine, University of Eastern Piedmont 'A. Avogadro', Novara, Italy

3 Santa Rita Hospital, Vercelli, Italy

4 Center for Health Services and Nursing Research, School of Public Health, Catholic University, Leuven, Belgium

5 European Pathway Association, Leuven, Belgium

For all author emails, please log on.

Citation and License

BMC Cardiovascular Disorders 2012, 12:81  doi:10.1186/1471-2261-12-81

Published: 25 September 2012



Care pathways have become a popular tool to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. We performed a disease specific systematic review to determine how care pathways in the hospital treatment of heart failure affect in-hospital mortality, length of in-hospital stay, readmission rate and hospitalisation cost when compared with standard care.


Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched from 1985 to 2010. Each study was assessed independently by two reviewers. Methodological quality of the included studies was assed using the Jadad methodological approach for randomised controlled trials, controlled clinical trials and the New Castle Ottawa Scale for case–control studies, cohort studies and time interrupted series.


Seven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials.


By combining all possible results, it can be concluded that care pathways for treatment of heart failure decrease mortality rates and length of hospital stay, but no statistically significant difference was observed in the readmission rates and hospitalisation costs. However, one should be cautious with overall conclusions: what works for one organization may not work for another because of the subtle differences in processes and bottlenecks.

Care pathways; Heart failure; Hospitalisation costs; Length of hospital stay; Mortality rate; Readmission rate