Thirty RCTs, with over 8,000 participants, were included in the review.
Twenty-two RCTs met at least five of the eight quality criteria.
All-cause admission.
There was a statistically significant reduction in all-cause admission for patients receiving multidisciplinary interventions compared with usual care (RR 0.87, 95% confidence interval, CI: 0.79, 0.95; 21 RCTs); however, significant heterogeneity was found. All-cause admission was statistically significantly reduced in the subgroup of patients receiving home visiting interventions (RR 0.80, 95% CI: 0.71, 0.89; 10 RCTs; no significant heterogeneity), but there was no significant difference between the intervention group and the usual care control group for the subgroups receiving telephone or mailing interventions (RR 0.86, 95% CI: 0.73, 1.02; 9 RCTs) and interventions delivered in a hospital, clinic or general practice (RR 0.99, 95% CI: 0.90, 1.10; 2 RCTs).
All-cause mortality.
There was a statistically significant reduction in all-cause mortality for patients receiving multidisciplinary interventions compared with usual care (RR 0.79, 95% CI: 0.69, 0.92; 27 RCTs); however, significant heterogeneity was found. Significant reductions in mortality were seen in the subgroup of patients receiving home or telemonitoring (RR 0.49, 95% CI: 0.33, 0.73; 3 RCTs) and the subgroup receiving telephone or mailing interventions (RR 0.70, 95% CI: 0.53, 0.94; 11 RCTs). There was significant heterogeneity for the telephone/mailing interventions subgroup. No significant reduction in all-cause mortality was seen for subgroups receiving home visiting interventions (RR 0.87, 95% CI: 0.72, 1.06; 11 RCTs) or interventions delivered in a hospital, clinic or general practice (RR 1.00, 95% CI: 0.84, 1.20; 3 RCTs).
Heart failure admission.
There was a statistically significant reduction in heart failure admission for patients receiving multidisciplinary interventions compared with usual care (RR 0.70, 95% CI: 0.61, 0.81; 16 RCTs); however, significant heterogeneity was found. Significant reductions in heart failure admission were seen in the subgroup of patients receiving home visiting interventions and the subgroup receiving telephone or mailing interventions (RR 0.62, 95% CI: 0.51, 0.74, and RR 0.70, 95% CI: 0.57, 0.85, respectively; no significant heterogeneity). No significant reduction in heart failure admission was seen for the subgroup of patients receiving interventions delivered in a hospital, clinic or general practice (RR 0.94, 95% CI: 0.78, 1.13).
Mean in-patient days.
There was a statistically significant reduction in the overall mean in-patient days of 1.9 days (95% CI: 0.7, 3.1) for patients receiving multidisciplinary interventions compared with usual care; there was no significant heterogeneity.
Quality of life.
Owing to the diversity of the quality-of-life scales used, data on quality of life were not synthesised or reported.
The sensitivity analyses showed that the quality of the studies had little impact on the effectiveness estimates for all-cause admission and all-cause mortality. However, when only low-intensity interventions were combined, the reductions in all-cause admission (RR 0.88, 95% CI: 0.76, 1.01) and all-cause mortality (RR 0.84, 95% CI: 0.66, 1.06) were no longer statistically significant. When studies that included only high-risk heart failure patients were pooled, the reduction in all-cause mortality was no longer statistically significant (RR 0.81, 95% CI: 0.58, 1.15).
The authors reported that funnel plots suggested little evidence of publication bias.