Systematic review of multidisciplinary interventions in heart failure.
OBJECTIVE
To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure.


METHODS
Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required.


METHODS
Randomised controlled trials conducted in both hospital and community settings.


METHODS
Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure.


METHODS
Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded.


METHODS
All cause hospital admission, all cause mortality, and heart failure hospital admission.


RESULTS
74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p = 0.002), although significant heterogeneity was found (p = 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p = 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p < 0.001). These results varied little with sensitivity analyses.


CONCLUSIONS
Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.
Holland
R
R
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK. r.holland@uea.ac.uk
Battersby
J
J
Harvey
I
I
Lenaghan
E
E
Smith
J
J
Hay
L
L
D002303:Cardiac Output, Low / Q000401:mortality* / Q000628:therapy; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D010348:Patient Care Team; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D016896:Treatment Outcome