Abstract: AIM:To observe the efficacy of out-of-hospital multifactorial intensive intervention on patients with chronic heart failure. METHODS: A prospective study was conducted in 215 patients with chronic heart failure. Patients were discharged from hospital and randomized into conventional follow-up group and intensive intervention group. The 215 patients were followed for 12 months and 205 of the patients completed the follow-up. Conventional follow-up group received only routine follow-up examination, whereas the intensive intervention group, in addition to the routine follow-up examination, received telephone counseling, specialized follow-up from heart failure clinics, and regular health education. RESULTS: The percentages of patients limiting water and salt intake and measuring body weight in intensive intervention group were markedly increased (P<0.01). The percentages of using diuretics and achieving target dose rate of ACEI/ARB/beta blockers were higher in intensive intervention group. The percentages of left ventricular ejection fraction and completing the 6-minute walking test were also higher in intensive intervention group, whereas the level of NT-pro-BNP was lower in intensive intervention group. Compared with those in the conventional follow-up group, the rehospitalization rate and incidence of cardiovascular events were lower in the intensive intervention group. CONCLUSION: Out-of-hospital multifactorial intensive intervention is helpful in improving the clinical outcome for patients with chronic heart failure.