Multidisciplinary and multisetting team management programme in heart failure patients affects hospitalisation and costing

Multidisciplinary and multisetting team management programme in heart failure patients affects hospitalisation and costing

We evaluated whether multidisciplinary disease management programme developed with collaboration of physicians and nurses inside and outside general district hospital settings can affect clinical outcomes in heart failure population over a 12-month period. 571 patients hospitalised with CHF were ref...

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Bibliographic Details
Published in:International journal of cardiology Vol. 111; no. 3; pp. 377 - 385
Main Authors: Piepoli, M.F., Villani, G.Q., Aschieri, D., Bennati, S., Groppi, F., Pisati, M.S., Rosi, A., Capucci, A.
Format: Journal Article
Language:English
Published: Shannon Elsevier Ireland Ltd 28-08-2006
Elsevier Science
Subjects:
Aged
Biological and medical sciences
Cardiology. Vascular system
Costing
Counseling
Disease Management
Education
Female
Health care
Heart
Heart Failure - economics
Heart Failure - therapy
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Hospitalization - economics
Hospitals, District - economics
Humans
Italy
Male
Medical sciences
Outcome and Process Assessment (Health Care)
Patient Care Team - economics
Patient Education as Topic
Prospective Studies
Italy
Health care
Costing
Disease management
Education
Human
Heart failure
Disease
Health
Cardiovascular disease
Phlebology
Care
Heart disease
Circulatory system
Cardiology
Multidisciplinary
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Summary:We evaluated whether multidisciplinary disease management programme developed with collaboration of physicians and nurses inside and outside general district hospital settings can affect clinical outcomes in heart failure population over a 12-month period. 571 patients hospitalised with CHF were referred to our unit and 509 patients agreed to participation. The intervention team included physicians and nurses from Internal Medicine and Cardiac Dept., and the patient's general practitioners. Contacts were on a pre-specified schedule, included a computerised programme of hospital visits and phone calls; in case of NYHA functional class III and IV patients, home visits were also planned. The median age of patients was 77.7 ± 9 years (43.3% women). At baseline the percentage of patients with NYHA class III and IV was 56.0% vs. 26.0% after 12 months ( P < 0.05). Programme enrolment reduced total hospital admissions (82 vs. 190, − 56%, P < 0.05), number of patients hospitalised (62 vs. 146, 57%, P < 0.05). All NYHA functional class benefited (class I = 75%, class IV = 67%), with reduction in the costing (− 48%, P < 0.05). Improvement in symptoms (− 9.0 ± 3.2) and signs (− 5.2 ± 3.1) scores was measured ( P < 0.01). Therapy optimisation was obtained by 20.5% increase in patients taking betablockade and 21.0% increase in those on anti-aldosterone drugs. Multidisciplinary approach to CHF management can improve clinical management, reducing hospitalisation rate and costing.
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ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2005.07.041