Comparative Effectiveness of Non-Pharmacological Interventions for Reducing Heart Failure-Related Unplanned...

Background: Heart failure (HF) is a major global health challenge associated with high morbidity, mortality, and frequent unplanned readmissions. These readmissions impose substantial physical, psychological, socioeconomic, and healthcare-system burdens. Although non-pharmacological interventions (NPIs) have shown promise in HF management, no network meta-analysis (NMA) has comprehensively compared their effects on HF-related unplanned readmissions. Methods: A computerized search was conducted on databases, including PubMed, Web of Science, Embase, the Cochrane Library, PsycINFO, and CINAHL for randomized controlled trials (RCTs) from inception to 15 March 2026. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. A frequentist NMA was conducted to synthesize direct and indirect evidence. The outcome was HF-related unplanned readmissions. Results: A total of 39 studies with 12 NPIs and 7333 patients were included. The NMA suggested that several NPIs were associated with reduced HF-related unplanned readmissions compared with usual care. Exercise therapy combined with multidisciplinary team management showed the highest ranking probability, with an RR of 0.32 (95% CI: 0.15 to 0.65), followed by patient education combined with health information tracking (RR: 0.42, 95% CI: 0.25 to 0.72), patient education alone (RR: 0.56, 95% CI: 0.46 to 0.69), and patient education combined with multidisciplinary team management (RR: 0.57, 95% CI: 0.43 to 0.78). Conclusions: Our NMA suggests that several NPIs may reduce HF-related unplanned readmissions, with exercise therapy combined with multidisciplinary team management showing the highest ranking probability and patient education combined with health information tracking also ranking favorably. Given the sparse head-to-head comparisons, heterogeneity across studies, and low certainty of evidence in some comparisons, these ranking-based findings should be cautiously interpreted as exploratory. Further multicenter RCTs are needed to confirm these findings and evaluate long-term effectiveness and implementation outcomes.