A systematic review and meta-analysis of cardiology-led care Vs general medical care in hospitalised acute decompensated heart failure patients: effects on in-hospital mortality and 30-day readmission

Background

Heart failure is the leading cause of admission to hospital in adults over 65yrs, with acute decompensated heart failure (ADHF) being a common cause for admission 1. The condition is clinically complex, often accompanied by multiple co-morbidities and significantly impacting quality of life2,3. Despite this, most ADHF patients are managed by general/internal medicine teams, with a minority receiving cardiology-led care4. This variation has prompted debate about its effect on outcomes. While some evidence suggests that specialist care may reduce mortality and readmission, findings remain inconsistent across the literature.

Purpose

To systematically review and meta-analyse the impact of cardiology-led care (gold standard) versus general medical care (usual care) in hospitalised acute decompensated heart failure patients, effects on in-hospital mortality and 30-day all-cause readmission.

Methods

A systematic search was conducted across MEDLINE, CINAHL Ultimate, Embase, the Cochrane Database of Systematic Reviews, and ProQuest Dissertation and Theses, from inception to March 2025. Inclusion criteria followed the PI/ECO framework and focused on quantitative studies involving adults with ADHF. Screening and quality appraisal were performed by the author in collaboration with an academic supervisor. Data were synthesised using JBI SUMARI, with risk of bias assessed via the JBI Checklist for Cohort Studies5. Both fixed- and random-effects models were used, and results were presented using forest plots. Sensitivity analysis was conducted for one outcome.

Results

Five observational cohort studies (two prospective6,7, three retrospective8,9,10) were included, involving 17,700 patients across five countries. Cardiology-led care was associated with a 49% relative risk reduction in in-hospital mortality (RR 0.51; 95% CI, 0.31-0.84) and a 13% reduction in 30-day readmission (RR 0.87; 95% CI, 0.80-0.96), compared to general medical care.

Conclusion

This meta-analysis indicates that cardiology-led care is associated with improved short-term outcomes in patients hospitalised with ADHF, notably reduced in-hospital mortality and 30-day readmission. Findings must be interpreted with caution as all included studies were observational cohorts, which carry inherent risks of bias/confounding, limiting the ability to draw causal conclusions. Uncontrolled factors such as illness severity, institutional practices and patient selection may have influenced outcomes.

There was heterogeneity in study designs, including small sample sizes, single-centre settings and restricted patient populations limiting generalisability. Additionally, inconsistencies in outcome definitions and potential publication bias contribute to uncertainty in the pooled results.

Despite limitations, the findings are consistent with previous evidence supporting the role of cardiology-led care in improving adherence to guideline-based management and care coordination.R.E. sensitivity in-hospital mortalityFor image description, please refer to the figure legend and surrounding text.F.M. 30-day readmissionFor image description, please refer to the figure legend and surrounding text.