Effects of three different disease management programs on outcomes in patients hospitalized with heart failure: a randomized trial

• Published in: Medicina clinica Vol. 138; no. 5; p. 192
• Main Authors: Gámez-López, Antonio Luis, Bonilla-Palomas, Juan Luis, Anguita-Sánchez, Manuel, Castillo-Domínguez, Juan Carlos, Arizón del Prado, José María, Suárez de Lezo, José
• Format: Journal Article
• Language: Spanish
• Published: Spain 03-03-2012
• Subjects: Aftercare - methods; Aged; Aged, 80 and over; Cardiovascular Agents - therapeutic use; Comorbidity; Disease Management; Female; Follow-Up Studies; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - therapy; Home Care Services, Hospital-Based - statistics & numerical data; Hospitalization - statistics & numerical data; House Calls - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Patient Discharge; Patient Readmission - statistics & numerical data; Telephone; Treatment Outcome
• ISSN: 1578-8989
• DOI: 10.1016/j.medcli.2011.03.027

Despite the recognized benefit of intervention programs in patients with heart failure (HF), it is unknown whether different types of programs have similar efficacy. The aim of our study was to compare the effectiveness of three different types of intervention.
208 patients discharged with the diagnosis of HF were randomized. Fifty-two were assigned to each one of different groups of intervention (home visits, telephone follow-up, HF unit) and 52 patients to usual care (control group).
Median follow-up was 10.8±3.2 months. During the study, the primary end point (HF hospitalization or death) was reached in: 20 patients (38.5%) in control group, 19 (36.5%) in telephone follow-up (HR 1.11; IC95% [0.59-2.01], p=0.79), 24 (46.2%) in home visits (HR 1.27; IC95% [0.69-2.32], p=0.78) and 23 patients (44.2%) in HF unit (HR 1.33; IC95% [0.73-0.42], p=0.79). There was a trend to higher hospitalizations (shorter) with lower mortality in intervention groups (mortality: 23.1% intervention groups vs 33.3% in control group, HR 0.61 IC al 95% [0.35-1.01], p=0.08).
In our study, the application of three different intervention programs in patients with HF has a little non-significant prognosis benefit, with a slight increase in the number of shorts hospitalizations in HF unit.