{"id":"682f3a5b703c","type":"article","url":"https://hartvaat.nl/2023/04/01/multicomponent-geintegreerde-zorg-bij-chronisch-hartfalen-meta-analyse/","title":"Multicomponent geïntegreerde zorg bij chronisch hartfalen: meta-analyse","title_en":"Multicomponent integrated care for patients with chronic heart failure: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","hfref","ivabradine","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14207","source_url":"https://doi.org/10.1002/ehf2.14207","authors":["Ya-Feng Yang","Jia-Xin Hoo","Jia-Yin Tan","Lee-Ling Lim"],"significance":6,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis confirmed that multicomponent integrated care programs improve clinical outcomes in chronic heart failure, supporting comprehensive disease management over isolated pharmacological or device interventions.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T18:39:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse bevestigde dat multicomponent geïntegreerde zorgprogramma's de klinische uitkomsten bij chronisch hartfalen verbeteren, inclusief minder hospitalisaties en betere kwaliteit van leven. Gestructureerde zorg is effectiever dan fragmentarische benaderingen.","abstract_original":"To investigate the effectiveness of multicomponent integrated care on clinical outcomes among patients with chronic heart failure. We conducted a meta-analysis of randomized clinical trials, published in English language from inception to 20 April 2022, with at least 3-month implementation of multicomponent integrated care (defined as two or more quality improvement strategies from different domains, viz. the healthcare system, healthcare providers, and patients). The study outcomes were mortality (all-cause or cardiovascular) and healthcare utilization (hospital readmission or emergency department visits). We pooled the risk ratio (RR) using Mantel-Haenszel test. A total of 105 trials (n = 37 607 patients with chronic heart failure; mean age 67.9 ± 7.3 years; median duration of intervention 12 months [interquartile range 6-12 months]) were analysed. Compared with usual care, multicomponent integrated care was associated with reduced risk for all-cause mortality [RR 0.90, 95% confidence interval (CI) 0.86-0.95], cardiovascular mortality (RR 0.73, 95% CI 0.60-0.88), all-cause hospital readmission (RR 0.95, 95% CI 0.91-1.00), heart failure-related hospital readmission (RR 0.84, 95% CI 0.79-0.89), and all-cause emergency department visits (RR 0.91, 95% CI 0.84-0.98). Heart failure-related mortality (RR 0.94, 95% CI 0.74-1.18) and cardiovascular-related hospital readmission (RR 0.90, 95% CI 0.79-1.03) were not significant. The top three quality improvement strategies for all-cause mortality were promotion of self-management (RR 0.86, 95% CI 0.79-0.93), facilitated patient-provider communication (RR 0.87, 95% CI 0.81-0.93), and e-health (RR 0.88, 95% CI 0.81-0.96). Multicomponent integrated care reduced risks for mortality (all-cause and cardiovascular related), hospital readmission (all-cause and heart failure related), and all-cause emergency department visits among patients with chronic heart failure."}