Effects of multifaceted optimization management for chronic heart failure: a multicentre, randomized controlled study

Area of Science:

• Cardiology
• Integrative Medicine
• Public Health

Background:

• Chronic heart failure (CHF) presents a significant global health challenge, necessitating innovative management strategies.
• The integration of Traditional Chinese Medicine (TCM) with conventional Western medicine offers a promising avenue for optimizing CHF care.
• A novel clinical pathway based on integrated TCM and Western medicine for CHF management has been developed.

Purpose of the Study:

• To assess the implementation effects of a multifaceted optimization management program for chronic heart failure (CHF).
• To evaluate the efficacy of an integrated approach combining usual care with Traditional Chinese Medicine (TCM) treatment.
• To compare the outcomes of the optimization program against conventional care in CHF patients.

Main Methods:

• Nine physicians in the optimization group received multifaceted interventions, including training, a written program, supervision, and performance monitoring.
• Nine physicians in the control group provided conventional care (usual care) without the multifaceted intervention.
• 256 CHF patients were randomly assigned to either the optimization program (integrated care) or the conventional program (usual care) for 24 weeks.

Main Results:

• The optimization group showed superior improvements in New York Heart Association (NYHA) functional classification at multiple time points (12, 16, 20, and 24 weeks).
• Significant benefits were observed in reduced readmission rates for major adverse cardiovascular events (MACEs) and worsening heart failure.
• Improvements were also noted in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, left ventricular ejection fraction (LVEF), TCM syndrome scores, and quality of life.

Conclusions:

• The multifaceted optimization program is feasible and beneficial for patients with CHF.
• The program improves NYHA functional classification, reduces heart failure readmissions, and enhances key clinical markers like NT-proBNP and LVEF.
• It also positively impacts TCM syndrome scores, quality of life, and adherence to evidence-based measures for heart failure with reduced ejection fraction (HFrEF).