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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials
Journal of the American College of Cardiology, Volume 44, No. 4, Year 2004
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Description
The aim of this study was to determine whether multidisciplinary strategies improve outcomes for heart failure (HF) patients. Because the prognosis of HF remains poor despite pharmacotherapy, there is increasing interest in alternative models of care delivery for these patients. Randomized trials of multidisciplinary management programs in HF were identified by searching electronic databases and bibliographies and via contact with experts. 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. 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. © 2004 by the American College of Cardiology Foundation.
Authors & Co-Authors
McAlister, Finlay A.
Canada, Edmonton
University of Alberta
Canada, Edmonton
University of Alberta Hospital
Stewart, Simon D.
Australia, Adelaide
University of South Australia
McMurray, John JV
United Kingdom, Glasgow
Western Infirmary
Statistics
Citations: 1,415
Authors: 3
Affiliations: 5
Identifiers
Doi:
10.1016/j.jacc.2004.05.055
ISSN:
07351097
Research Areas
Genetics And Genomics
Health System And Policy
Study Design
Cohort Study
Study Approach
Systematic review