title: Multidisciplinary management of chronic heart failure: principles and future trends.
abstract: OBJECTIVE
  Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF.
  
  
  METHODS
  Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management.
  
  
  RESULTS
  Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention.
  
  
  CONCLUSIONS
  Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions.
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland; Faculty of Health, University of Technology, Sydney, Australia. Electronic address: pdavidson@jhu.edu.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.affiliation: Faculty of Health, University of Technology, Sydney, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Thitipong
authors.initials: T
authors.lastname: Tankumpuan
authors.affiliation: Faculty of Health, University of Technology, Sydney, Australia; St George Hospital, Sydney, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Paull
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dennison-Himmelfarb
mesh_terms: D002908:Chronic Disease; D003695:Delivery of Health Care; D019468:Disease Management; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D010348:Patient Care Team; D017410:Practice Guidelines as Topic
keywords: Heart failure; disease management; health services; multidisciplinary