Improving Heart Failure Outcomes in Ambulatory and Community Care: A Scoping Study

Area of Science:

• Health Services Research
• Cardiology
• Implementation Science

Background:

• Heart failure (HF) care remains suboptimal despite extensive research on interventions.
• Organizational interventions are crucial for improving HF outcomes in ambulatory settings.
• Existing literature often lacks detailed reporting, hindering intervention scalability.

Purpose of the Study:

• To conduct a scoping study of organizational interventions aimed at improving heart failure outcomes in ambulatory settings.
• To identify effective intervention types and assess their impact on key HF metrics.
• To highlight gaps in current research, particularly concerning comorbidities and vulnerable populations.

Main Methods:

• A scoping review methodology was employed.
• Included 52 studies and systematic reviews evaluating multicomponent, self-management support, and eHealth interventions.
• Focused on interventions within ambulatory care settings.

Main Results:

• Multicomponent interventions, dating back to the 1990s, demonstrated reductions in hospitalizations, readmissions, mortality, and costs, alongside improved quality of life.
• Self-management support was most effective when integrated into multicomponent interventions.
• The independent impact of eHealth interventions requires further clarification.
• Significant gaps exist in addressing comorbidities, geriatric syndromes, frailty, and end-of-life care.
• Research on risk stratification and vulnerable populations was limited.

Conclusions:

• Multicomponent interventions show promise for improving heart failure care, but their integration with self-management support is key.
• Current research lacks comprehensive reporting on intervention details and implementation, impeding widespread adoption and scaling.
• Future research should focus on addressing care gaps and utilizing standardized reporting to facilitate health system redesign.