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Multidisciplinary management of chronic heart failure: principles and future trends
Patricia M Davidson1, Phillip J Newton2, Thitipong Tankumpuan3
1Johns Hopkins University School of Nursing, Baltimore, Maryland; Faculty of Health, University of Technology, Sydney, Australia.
Insights
Multidisciplinary care improves chronic heart failure (CHF) management, but evidence on specific effective components and delivery is limited. Future research should address health system, provider, and patient factors for better CHF care.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Chronic heart failure (CHF) presents a significant global health systems challenge due to high disease burden and hospitalization costs.
- Effective CHF management requires multidisciplinary approaches focusing on quality, access, efficiency, and equity.
- Adherence and fidelity to program elements are crucial for successful multidisciplinary CHF care.
Purpose of the Study:
- To summarize evidence on multidisciplinary management of chronic heart failure (CHF).
- To provide recommendations for advancing practice, education, research, and policy in CHF multidisciplinary care.
- To address the complexities of implementing and evaluating interventions for chronic heart failure.
Main Methods:
- Identified essential elements of multidisciplinary CHF management from meta-analyses and clinical practice guidelines.
- Analyzed study factors from the perspectives of healthcare systems, providers, patients, and caregivers.
- Utilized identified evidence gaps to guide future research directions in CHF multidisciplinary management.
Main Results:
- High-level evidence supports the efficacy of management programs for chronic heart failure (CHF).
- Limited evidence exists on the specific benefits of individual program components or their optimal delivery methods.
- Healthcare system, provider, and patient factors significantly influence CHF management models and require focused attention.
Conclusions:
- Heterogeneity in study populations and intervention implementation limits generalizability of trial findings to diverse clinical settings.
- Developing and assessing programs that consider diverse factors is integral to optimizing patient and organizational outcomes in CHF care.
- Acknowledging the complexity of multidisciplinary CHF interventions is vital for advancing their design, implementation, and evaluation.
Purpose:
Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF.
Methods:
Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management.
Findings:
Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention.
Implications:
Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions.
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