A multicenter disease management program for hospitalized patients with heart failure
Despite the availability of proven therapies, outcomes in patients with heart failure (HF) remain poor. In this 2-stage, multicenter trial, we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF. In Stage 1, a pharmacist or nurse assessed each p...
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Veröffentlicht in: | Journal of cardiac failure 2004-12, Vol.10 (6), p.473-480 |
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Sprache: | eng |
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Zusammenfassung: | Despite the availability of proven therapies, outcomes in patients with heart failure (HF) remain poor. In this 2-stage, multicenter trial, we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF.
In Stage 1, a pharmacist or nurse assessed each patient and made recommendations to the physician to add or adjust angiotensin-converting enzyme (ACE) inhibitors and other HF medications. Before discharge (Stage 2), patients were randomized to a patient support program (PSP) (education about HF, self-monitoring, adherence aids, newsletters, telephone hotline, and follow-up at 2 weeks, then monthly for 6 months after discharge) or usual care. In Stage 1 (766 patients) ACE inhibitor use increased from 58% on admission to 83% at discharge (
P < .0001), and the daily dose (in enalapril equivalents) increased from 11.3±8.8 mg to 14.5±8.8 mg (
P < .0001). In Stage 2 (276 patients) there was no difference in ACE inhibitor adherence, but a reduction in cardiovascular-related emergency room visits (49 versus 20,
P
=
.030), hospitalization days (812 versus 341,
P
=
.003), and cost of care ($CDN 2,531 less per patient) in favor of the PSP.
Simple interventions can improve ACE inhibitor use and patient outcomes. |
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ISSN: | 1071-9164 1532-8414 |
DOI: | 10.1016/j.cardfail.2004.02.005 |