Effectiveness of Multidisciplinary Clinic Integration on Long-Term Mortality in Chronic Heart Failure: A Regional Registry Study

Abstract

Background: Despite established guidelines, significant variation persists in the delivery of chronic Heart Failure (HF) care, particularly in regional contexts. Multidisciplinary care (MDC) is proven to enhance adherence to Guideline-Directed Medical Therapy (GDMT), yet its long-term survival benefit across diverse regional cohorts, independent of initial patient selection biases, remains under-documented. We utilized regional registry data to assess the real-world impact of systematic MDC integration on all-cause mortality.

Methods: This retrospective cohort study utilized data from the Regional HF Patient Registry, enrolling 2,800 consecutive patients newly diagnosed with HFrEF or HFpEF over a five-year period. Patients were categorized by referral pathway: specialized Multidisciplinary HF Clinic (MDC) or Standard Cardiology Care (SCC). To mitigate confounding by indication, a robust Propensity Score Matching (PSM) algorithm was applied to balance baseline demographics and comorbidities (e.g., age, LVEF, comorbidity index). The primary endpoint was all-cause mortality at 36 months. Multivariate Cox Proportional Hazards regression served as the primary statistical analysis.  

Results: After meticulous PSM, 1,200 matched pairs (MDC vs. SCC) were analyzed. Patients managed through the Multidisciplinary Clinic demonstrated a significantly improved survival rate. The adjusted Hazard Ratio (HR) for all-cause mortality at 36 months in the MDC group was 0.72 (95% CI: 0.61–0.85; p<0.001), indicating a 28% relative risk reduction. Furthermore, the rate of 30-day readmission for acute HF exacerbation was reduced by 35% in the MDC group (p=0.012). This outcome highlights the clinical superiority of integrated care delivery. Notably, the survival benefit persisted irrespective of the baseline LVEF status. 

Conclusion: Systematic integration of Multidisciplinary Heart Failure Clinics significantly improves long-term survival and reduces hospitalization rates in a regional, real-world cohort. These data underscore the critical need for policy frameworks that mandate centralized, integrated care structures, directly supporting the regional objective of enhancing quality of care and optimizing chronic disease management.