Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
Heart. 2005 Jul;91(7):899-906. doi: 10.1136/hrt.2004.048389.
To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure.
Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required.
Randomised controlled trials conducted in both hospital and community settings.
Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure.
Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded.
All cause hospital admission, all cause mortality, and heart failure hospital admission.
74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p = 0.002), although significant heterogeneity was found (p = 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p = 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p < 0.001). These results varied little with sensitivity analyses.
Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.
确定多学科干预对心力衰竭患者住院率和死亡率的影响。
系统评价。检索了13个数据库，并检查了纳入试验和相关综述的参考文献列表。如有需要，会与试验作者联系。
在医院和社区环境中进行的随机对照试验。
如果所有患者或特定亚组患者被诊断为心力衰竭，则纳入该试验。
多学科干预被定义为心力衰竭管理由多学科团队负责，包括医学投入以及以下一项或多项：专科护士、药剂师、营养师或社会工作者。干预措施分为四个相互排斥的组：提供家访；家庭生理监测或视频链接；电话随访但不进行家访；以及仅进行医院或诊所干预。排除基于药物和运动的干预措施。
全因住院率、全因死亡率和心力衰竭住院率。
共识别出74项试验，其中30项包含可纳入荟萃分析的相关数据。多学科干预降低了全因住院率（相对风险（RR）0.87，95%置信区间（CI）0.79至0.95，p = 0.002），尽管存在显著异质性（p = 0.002）。全因死亡率也有所降低（RR 0.79，95% CI 0.69至0.92，p = 0.002），心力衰竭住院率也是如此（RR 0.70，95% CI 0.61至0.81，p < 0.001）。敏感性分析结果变化不大。
心力衰竭的多学科干预可降低住院率和全因死亡率。最有效的干预措施至少部分在家庭中实施。
