Effectiveness of multidisciplinary disease management for patients with heart failure: a systematic review and meta-analysis
M Shimbo, T Nakade, M Murata, T Taniguchi, K Kida, H Shiraishi, T SekiAbstract
Background
Comprehensive disease management through a multidisciplinary team approach is recommended for heart failure (HF) patients. Although multidisciplinary disease management (MDM), such as nurse-led management, dietary counseling, or telemonitoring, are widely implemented, the prognostic impact of each type of intervention in patients with HF has not been fully established.
Purpose
To evaluate the effects of MDMs on mortality and morbidities in patients with HF.
Methods
We conducted a systematic review and meta-analysis using the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and PubMed from inception to November 2024. Randomized controlled trials comparing MDMs with usual care in patients with HF were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The effects of MDMs were examined. Random-effects meta-analyses were performed to estimate relative risks (RR). Outcomes included all-cause mortality and HF hospitalizations.
Results
A total of 515 studies involving 72,870 patients with median follow-up of 6 months were included. MDMs were associated with reduced all-cause mortality (RR 0.81; 95% confidence interval (CI) 0.76–0.86). All-cause mortality was also reduced with disease management programs (RR 0.80; 95% CI 0.71–0.91), nurse-led management (RR 0.80; 95% CI 0.70–0.93), and telemonitoring (RR 0.78; 95% CI 0.66–0.93), whereas dietary counseling, education, psychological, and transitional care interventions were not. HF-related hospitalizations were similarly reduced (RR 0.72; 95% CI 0.65–0.79), with the same intervention categories.
Conclusions
In patients with HF, MDMs particularly disease management programs, nurse-led management and telemonitoring were associated with improved survival and reduced HF hospitalization. These findings support structured implementation of targeted multidisciplinary strategies in HF care.