The costs and outcomes of multifaceted interventions designed to improve the care of congestive heart failure in the inpatient setting: a review of the literature.

Various multifaceted interventions have been developed in response to the overwhelming burden of congestive heart failure and its costs. These interventions range from improvements in the delivery of inpatient care (e.g., by assigning multidisciplinary teams to the care of a patient or ensuring that clinical practice guidelines are followed) to comprehensive discharge planning that includes home health care. While it is intuitive that such interventions improve care, few have been evaluated in randomized controlled trials and fewer still include data on costs. In this article, the authors review the findings of randomized controlled trials of interventions designed to improve the quality of life, decrease hospital admissions, and decrease costs associated with heart disease. They conclude that inpatient-based multifaceted interventions appear to be effective and inexpensive. Future studies should attempt to tease interventions apart to ascertain which are the most effective. Formal cost-effectiveness analyses are also needed.