The Impact of Online-Offline Integrated Out-of-hospital Education on Patients with Heart Failure: A Systematic Review and Meta-Analysis

AIM: Poor post-discharge management worsens heart failure (HF) outcomes. Integrated online-offline education (O2O-IOPE) may improve clinical outcomes but remains unquantified. This systematic review and meta-analysis aims to evaluate the effects of O2O-IOPE on the health outcomes of patients with HF. METHODS AND RESULTS: We searched PubMed, The Cochrane Library, Embase, Web of Science, CNKI, and Wanfang Data from database inception to April 18, 2025, for randomized controlled trials (RCTs) on O2O-IOPE in patients with HF. A total of 13 studies were ultimately included, involving 3,216 patients. Quantitative analyses showed that O2O-IOPE can reduce all-cause mortality (RR = 0.61, 95% CI = 0.46 to 0.81, P < 0.01), improve patients' left ventricular ejection fraction (LVEF) (MD = 0.66, 95% CI = 0.11 to 1.21, P = 0.02), quality of life (SMD = -0.82, 95% CI = -1.00 to -0.65, P < 0.01), and self-care ability (SMD = 1.81, 95% CI = 0.73 to 2.90, P < 0.01). However, non-significant effects were observed on rehospitalization rate (RR = 0.88, 95% CI = 0.49 to 1.57, P = 0.66), 6-minute walk test (6MWT) (MD = 69.84, 95% CI = -13.76 to 153.43, P = 0.10), or health-related knowledge (SMD = 3.09, 95% CI = -1.55 to 7.72, P = 0.19). Qualitative synthesis suggested potential benefits in NYHA class, medication adherence, depressive symptoms, and self-efficacy; however, because these findings were each derived from single studies, they should be considered preliminary and not conclusive. CONCLUSION: The O2O-IOPE framework significantly improves mortality, cardiac function, quality of life, and self-care in patients with HF. Its effectiveness appears to depend more on the quality of integration, particularly active response mechanisms and structured offline components, than on specific digital tools or delivery settings. Future research should focus on optimizing integration strategies and evaluating long-term outcomes across diverse populations.