Does multidisciplinary disease management program lower hospitalization and mortality among patients with heart failure? A systematic review and meta-analysis of randomized controlled trials.

backgroundAs the burden of Heart failure (HF) continues to rise, effective management strategies are essential. Multidisciplinary disease management programs (DMPs) have been recommended as a promising approach to improving clinical outcomes. The aim of this study was to evaluate the effectiveness of multidisciplinary DMPs in terms of HF mortality, all-cause mortality, HF admissions, and all-cause admissions, compared to usual care.

methodsThis systematic review and meta-analysis adhered to PRISMA guidelines. A comprehensive search was conducted from January 1990 to December 2025 in databases and trial registries, including ClinicalTrials.gov, the WHO International Clinical Trial Registry Platform, Web of Science, MEDLINE, Embase, and Cochrane. Randomized controlled trials comparing DMPs to usual care were included. Outcomes assessed were HF readmissions, all-cause readmissions, HF mortality, and all-cause mortality. The risk of bias was evaluated using the Cochrane Risk of Bias (ROB 2) tool. A random-effects model was used due to significant heterogeneity, and a fixed-effect model was applied in sensitivity and subgroup analyses. The GRADE framework was used to assess the certainty of the evidence.

resultsThe analysis included 32 studies involving 9,934 participants (5,145 in the intervention group and 4,789 in the control group). DMPs may reduce HF readmissions (RR 0.76, 95% CI 0.66–0.88; I² = 59%; NNT = 16) and all-cause readmissions (RR 0.88, 95% CI 0.81–0.96; I² = 55%; NNT = 18). DMPs may also reduce all-cause mortality (RR 0.82, 95% CI 0.73–0.92; I² = 33%; NNT = 26) %). Limited data suggested a possible reduction in HF mortality. Certainty of evidence was rated as very low for HF readmissions, low for all-cause readmissions, very low for all-cause mortality, and low for HF mortality. Subgroup analyses revealed that clinic-based DMPs had the highest mortality benefit, although home-based and telemedicine-supported DMPs were more successful in reducing readmissions. Effects were consistent for both short-term (≤ 6 months) and long-term (> 6 months) follow-up. Single-center trials produced greater impacts than multicenter trials.

conclusionMultidisciplinary HF-DMPs reduce HF and all-cause readmissions while improving all-cause mortality, especially in clinic-based settings. Evidence for HF mortality reduction remains limited and should be interpreted with caution. DMP design, delivery procedure, and trial setting all impact effectiveness, emphasizing the necessity of tailored DMP implementation to the healthcare system. These findings support incorporating DMPs into standard care to enhance outcomes. Further rigorous studies are recommended to confirm and refine these results.

trial registrationPROSPERO CRD42023464413.