Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials.
OBJECTIVE
The aim of this study was to determine whether multidisciplinary strategies improve outcomes for heart failure (HF) patients.


BACKGROUND
Because the prognosis of HF remains poor despite pharmacotherapy, there is increasing interest in alternative models of care delivery for these patients.


METHODS
Randomized trials of multidisciplinary management programs in HF were identified by searching electronic databases and bibliographies and via contact with experts.


RESULTS
Twenty-nine trials (5,039 patients) were identified but were not pooled, because of considerable heterogeneity. A priori, we divided the interventions into homogeneous groups that were suitable for pooling. Strategies that incorporated follow-up by a specialized multidisciplinary team (either in a clinic or a non-clinic setting) reduced mortality (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.59 to 0.96), HF hospitalizations (RR 0.74, 95% CI 0.63 to 0.87), and all-cause hospitalizations (RR 0.81, 95% CI 0.71 to 0.92). Programs that focused on enhancing patient self-care activities reduced HF hospitalizations (RR 0.66, 95% CI 0.52 to 0.83) and all-cause hospitalizations (RR 0.73, 95% CI 0.57 to 0.93) but had no effect on mortality (RR 1.14, 95% CI 0.67 to 1.94). Strategies that employed telephone contact and advised patients to attend their primary care physician in the event of deterioration reduced HF hospitalizations (RR 0.75, 95% CI 0.57 to 0.99) but not mortality (RR 0.91, 95% CI 0.67 to 1.29) or all-cause hospitalizations (RR 0.98, 95% CI 0.80 to 1.20). In 15 of 18 trials that evaluated cost, multidisciplinary strategies were cost-saving.


CONCLUSIONS
Multidisciplinary strategies for the management of patients with HF reduce HF hospitalizations. Those programs that involve specialized follow-up by a multidisciplinary team also reduce mortality and all-cause hospitalizations.
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca
Finlay A
FA
McAlister
Simon
S
Stewart
Stefania
S
Ferrua
John J J V
JJ
McMurray
D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012307:Risk Factors