We sought to determine whether a multidisciplinary outpatient management program decreases chronic heart failure (CHF) hospital readmissions and mortality over a six-month period.
Background
Hospital admission for CHF is an important problem amenable to improved outpatient management.
Methods
Two hundred patients hospitalized with CHF at increased risk of hospital readmission were randomized to a multidisciplinary program or usual care. A study cardiologist and a CHF nurse evaluated each patient and made recommendations to the patient’s primary physician before randomization. The intervention team consisted of a cardiologist, a CHF nurse, a telephone nurse coordinator and the patient’s primary physician. Contact with the patient was on a prespecified schedule. The CHF nurse followed an algorithm to adjust medications. Patients in the nonintervention group were followed as usual. The primary outcome was the composite of the number of CHF hospital admissions and deaths over six months, compared by using a log transformation ttest by intention-to-treat analysis.
Results
The median age of the study patients was 63.5 years, and 39.5% were women. There were 43 CHF hospital admissions and 7 deaths in the intervention group, as compared with 59 CHF hospital admissions and 13 deaths in the nonintervention group (p = 0.09). The quality-of-life score, percentage of patients on target vasodilator therapy and percentage of patients compliant with diet recommendations were significantly better in the intervention group. Cost per patient, in 1998 U.S. dollars, was similar in both groups.
Conclusions
This study demonstrates that a six-month, multidisciplinary approach to CHF management can improve important clinical outcomes at a similar cost in recently hospitalized high-risk patients with CHF.
Partial funding was provided by CardioContinuum, Inc., Rockville, Maryland. Under a licensing agreement between The Johns Hopkins University and CardioContinuum, the University and, in particular, its Division of Cardiology, are entitled to royalty on the use of the CHF management program described in this study. The University also owns CardioContinuum stock, which is subject to certain restrictions under University policy. The University, in accordance with its conflict of interest policies, is managing the terms of this arrangement. None of the investigators, with the exception of Ms. Van Anden (once an employee of CardioContinuum), have personal stock, royalty interests or consulting arrangements with CardioContinuum.
