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Systematic review of multidisciplinary interventions in heart failure
  1. R Holland,
  2. J Battersby,
  3. I Harvey,
  4. E Lenaghan,
  5. J Smith,
  6. L Hay
  1. School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk, UK
  1. Correspondence to:
    Dr Richard Holland
    School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK; r.hollanduea.ac.uk

Abstract

Objective: To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure.

Design: 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.

Setting: Randomised controlled trials conducted in both hospital and community settings.

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

Interventions: 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.

Main outcome measures: 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.

Conclusion: 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.

  • ACE, angiotensin converting enzyme
  • AMED, Allied and Complementary Medicine
  • CI, confidence interval
  • CINAHL, Cumulative index to Nursing and Allied Health Literature
  • COACH, coordinating study evaluating outcomes of advising and counselling in heart failure
  • DARE, Database of Abstracts of Reviews of Effects
  • NHS, National Health Service
  • TEN-HMS, Trans-European Network initiative–homecare management system study
  • heart failure
  • hospital admission
  • mortality
  • multidisciplinary interventions
  • systematic review
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    Files in this Data Supplement:

    • [view PDF] - Table 1. Included studies � baseline data on trial participants and trial quality.
    • [view PDF] - Table 2. Description of interventions provided.

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