A Systematic Literature Review of Coordinated Care in Cardiovascular-Kidney-Metabolic Conditions

Abstract

Objective

To assess coordinated cardiovascular-kidney-metabolic (CKM) care programs, including program types, components, and outcomes.

Patients and Methods

We searched Embase and Medline for studies from January 1, 2015 through March 9, 2023, and congress abstracts from January 1, 2021 through March 9, 2023. For inclusion, patients were required to have ≥2 CKM conditions and the coordinated care program assessed the effectiveness of either treatment, monitoring, or risk reduction of all 3 conditions. Two reviewers extracted and assessed the data for accuracy. Randomized controlled trials were assessed for potential bias in the design, conduct, and reporting of clinical trials risk of bias using the Cochrane risk of bias tool, version 2. Observational studies were assessed using the Newcastle-Ottawa Scale.

Results

A total of 22 international studies met our inclusion criteria; interventions included patient visits to multidisciplinary team (MDT) care clinics (n=9), pharmacist integration (n=5), patient engagement and education (n=6), or MDT/multispecialty team meetings (n=2). The sample size of studies ranged from 14 to 9601. Overall, results showed greater patient satisfaction and fewer health-related problems with coordinated care programs versus usual care, with increased attendance rates and decreased health care costs for virtual consultations, and further reductions for programs integrating telehealth.

Conclusion

Coordinated care for patients with CKM conditions may improve clinical outcomes and reduce healthcare costs. Future research is needed to develop programs with standard reporting, to assess overall effectiveness, and to identify best practices for implementing coordinated care programs. Limitations included heterogeneity in the interventions’ design, delivery, CKM population, and outcomes assessed.

Trial Registration

PROSPERO Identifier: CRD42023409731