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Disease management program improved mortality risk, well-being in HF patients
Angermann C. Circ Heart Fail. 2011;doi:10.1161/CIRCHEARTFAILURE.111.962969.
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According to results of an analysis of the Interdisciplinary Network for Heart Failure study, patients hospitalized for systolic HF who were randomly assigned to a nurse-coordinated disease management program vs. usual care experienced similar outcomes in time to all-cause death or rehospitalization but improvements in mortality risk and well-being.
Researchers randomly assigned 715 patients with signs and symptoms of decompensated HF and left ventricular ejection fraction of 40% or less to two disease management programs: a nurse-coordinated, individualized disease management program (HeartNetCare-HF) or usual care. Medical history, physical status, blood chemistry, 12-lead electrocardiogram, echocardiography, pulmonary function testing and generic quality of life (SF-36) were all evaluated before patients were discharged.
According to study results, 37% of patients assigned to the disease management program vs. 38% of patients assigned to usual care reached primary endpoint of time to all-cause death or rehospitalization within 180 days (HR=1.02; 95% CI, 0.81-1.30). Death occurred more often in the usual-care group (32 vs. 52 deaths; HR=0.62; 95% CI, 0.40-0.96). Rehospitalization was more common in the disease management program group (HR=1.15; 95% CI, 0.89-1.49). The disease management program was also associated with more favorable results in NYHA class (P=.05), physical functioning (P=.03) and physical health component (P=.03) at 180-day clinical evaluation. Additionally, the researchers found that health care utilization was comparable between groups, but a higher rate of patients in the disease management program group requested counseling for noncardiac problems more frequently than CV- or HF-related issues.
“Our findings encourage health care strategies aiming to align different care modules in multidisciplinary collaborative programs and integrating novel telemonitoring technologies with comprehensive individualized care for both cardiac and noncardiac problems in efforts to achieve more sustainable improvement in HF outcomes,” the researchers concluded.
Disclosure: Dr. Angermann reports no relevant financial disclosures.
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