Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials.

@article{citeulike:1218058, abstract = {OBJECTIVES: 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.}, address = {Division of General Internal Medicine, University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca}, author = {McAlister, F. A. and Stewart, S. and Ferrua, S. and McMurray, J. J. }, citeulike-article-id = {1218058}, doi = {http://dx.doi.org/10.1016/j.jacc.2004.05.055}, issn = {0735-1097}, journal = {J Am Coll Cardiol}, keywords = {chf, readmission}, month = {August}, number = {4}, pages = {810--819}, posted-at = {2007-04-09 17:58:00}, priority = {2}, title = {Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials.}, url = {http://dx.doi.org/10.1016/j.jacc.2004.05.055}, volume = {44}, year = {2004} }

TY - JOUR ID - citeulike:1218058 L3 - citeulike-article-id:1218058 TI - Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. JF - J Am Coll Cardiol VL - 44 IS - 4 SP - 810 EP - 819 AD - Division of General Internal Medicine, University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca SN - 0735-1097 N2 - OBJECTIVES: 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. KW - chf KW - readmission AU - McAlister, FA AU - Stewart, S AU - Ferrua, S AU - McMurray, JJ PY - 2004/08/18/ UR - http://dx.doi.org/10.1016/j.jacc.2004.05.055 ER -