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Table 2 Evidence- and guideline-based medications that reduce emergency hospital admissions

From: Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments

Author, YearID No. Patient population Medication treatment Control Patients (RCTs) Mean agea Outcome and mean follow-upb NNT (95% CI)
RR (95% CI)
I2% Quality of evidencec Clinical guideline support
America UK Europe
Reduces hospital admissions from out-patient, day-procedure or community settings
 Xie, 20168916a Heart failure with reduced left ejection fraction or left ventricular dysfunction ACE inhibitors Placebo 12,763 (5) 62 ± 4 HF hospitalisation at 32 months NNT: 19 (16 to 25)
RR: 0.71 (0.66 to 0.78)
0 Moderate AHA,
ACC
NICE ESC
 Xie, 20168916b Angiotensin-II receptor blockers Placebo 9878 (4) 65 ± 2 HF hospitalisation at 26 months NNT: 19 (14 to 30)
RR: 0.77 (0.70 to 0.86)
30 Moderate AHA,
ACC
NICE ESC
 Xie, 20168916c Aldosterone antagonists Placebo 11,477 (4) 65 ± 3 HF hospitalisation at 18 months NNT: 22 (15 to 55)
RR: 0.71 (0.57 to 0.88
74 Moderate AHA,
ACC
NICE ESC
 Hood, 20143415 Digoxind Placebo 7262 (4) 61 ± 3 Hospitalisation at 12 months NNT: 28 (23 to 37)
RR: 0.71 (0.64 to 0.77)
29 High AHA,
ACC
NICE ESC
 Le, 20168817a Heart failure with prior MI Aldosterone antagonists Placebo 15,786 (13) 63 ± 6 Hospitalisation at 15 months NNT: 67 (39 to 233)
RR: 0.93 (0.88 to 0.98)
35 Moderate AHA,
ACC
NICE  
 Afilalo, 2007100c Stable coronary artery disease Intensive statin therapy Moderate statin therapy 27,547 (4) 61 ± 2 HF hospitalisation at 41 months NNT: 115 (84 to 189)
RR: 0.73 (0.63 to 0.83)
4 Moderate AHA,
ACC
NICE ESC; EAS
 Kew, 20134002h Stable COPD Long-acting beta 2 agonists Placebo 3804 (7) 62 ± 2 COPD hospitalisation at 9 months NNT: 77 (47 to 420)
RR: 0.74 (0.57 to 0.95)
35 Moderate ATSe NICE ESRe
 Ni, 20148850a Long-acting muscarinic antagonistsf Placebo 5624 (10) 64 ± 3 COPD hospitalisation at 9 months NNT: 106 (70 to 321)
RR: 0.65 (0.47 to 0.88)
0 High ATS NICE ESR
Reduces hospital admissions from the emergency department
 Edmonds, 20122159 Acute asthma exacerbation Early use of inhaled corticosteroids Placebo 377 (5) 38 ± 8 Hospitalisation, Follow-up unclear NNT: 7 (5 to 12)
RR: 0.42 (0.25 to 0.67)
0 Moderate ATS NICE  
 Rodrigo, 20056568a Anticholinergics Beta 2 agonists 1556 (9) 18 to 55 Hospitalisation at ED discharge NNT: 12 (8 to 26)
RR: 0.68 (0.53 to 0.86)
14 Moderate ATS NICE  
Reduces readmissions after an index hospital admission
 Leucht, 20124508a Schizophrenia Antipsychotic maintenance therapy No maintenance or placebo 2090 (16) 38 ± 9 Rehospitalisation at 11 months NNT: 5 (4 to 7)
RR: 0.38 (0.27 to 0.55)
45 High APA NICE EPAg
 Kishimoto, 20134065a Second-generation antipsychotics First-generation antipsychotics 2869 (12) 33 ± 6 Hospitalisation at 13 months NNT: 17 (12 to 48)
RR: 0.72 (0.58 to 0.90)
18 Moderate APA NICE EPAg
  1. ID No. identification number, RCT randomised controlled trial, NNT number needed to treat to avoid one emergency hospital admission, RR risk ratio, CI confidence interval, ED emergency department, ACE angiotensin-converting enzyme, HF heart failure, COPD chronic obstructive pulmonary disease, MI myocardial infarction, NICE National Institute for Health and Care Excellence, ESC European Society of Cardiology, AHA American Heart Association, ACC American College of Cardiology, EAS European Atherosclerosis Society, ATS American Thoracic Society, ESR European Respiratory Society, APA American Psychiatric Association, EPA European Psychiatric Association
  2. aMeans and standard deviations for patient ages in years. Mean of means and median ages in trials contributing to the pooled estimate. Not all included trials reported age in a form that could be averaged
  3. bMean length of follow-up across trials, unless otherwise specified. Mean of means, medians and total study durations reported in trials contributing to the pooled estimate. Not all included trials reported follow-up in a form that could be averaged. Rounded to the nearest whole month
  4. cModerate- or high-quality evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group criteria
  5. dFor patients with normal sinus rhythm
  6. eThe ESR/ATS suggested in their joint 2012 guideline that long-acting beta 2 agonists are a clinically acceptable treatment for stable COPD. However, in their 2017 guideline on preventing exacerbations, they recommended monotherapy with long-acting muscarinic antagonists in preference to long-acting beta 2 agonists if the treatment goal is to prevent a future exacerbation. They indicated that this recommendation places less emphasis on symptomatic relief and that the differential effect on mortality or adverse events is unknown
  7. fAclidinium bromide. Four other meta-analyses with moderate-quality evidence examined other long-acting muscarinic antagonists (e.g. tiotropium) and reported similar effects
  8. gThe European Psychiatric Association has not published a clinical guideline for schizophrenia but has published a review of national guidelines across Europe and found significant agreement with respect to use of antipsychotic maintenance therapy and of second-generation antipsychotics