Mode of Action and Effects of Standardized Collaborative Disease Management on Mortality and Morbidity in Patients With Systolic Heart Failure

• DOI: 10.1161/circheartfailure.111.962969
• Publication Date: 2011-09-29T00:31:29Z
• Authors: Christiane E. Ang...; Stefan Störk; Götz Gelbrich; Hermann Faller; Roland Jahns; Stefan Frantz; Markus Loeffler; Georg Ertl
• Keywords: Clinical endpoint; Disease management

Background— Trials investigating efficacy of disease management programs (DMP) in heart failure reported contradictory results. Features rendering specific interventions successful are often ill defined. We evaluated the mode action and effects a nurse-coordinated DMP (HeartNetCare-HF, HNC). Methods Results— Patients hospitalized for systolic were randomly assigned to HNC or usual care (UC). Besides telephone-based monitoring education, addressed individual problems raised by patients, pursued networking health providers provided training caregivers. End points time death rehospitalization (combined primary), symptoms, quality life (SF-36). Of 1007 consecutive 715 (HNC: n=352; UC: n=363; age, 69±12 years; 29% female; 40% New York Heart Association class III-IV). Within 180 days, 130 137 UC patients reached primary end point (hazard ratio, 1.02; 95% confidence interval, 0.81–1.30; P =0.89), since more readmitted. Overall, 32 52 died (1 patient 4 after dropout); thus, uncensored hazard ratio was 0.62 (0.40–0.96; =0.03). improved regarding ( =0.05), physical functioning =0.03), component Except HNC, utilization comparable between groups. However, requested counseling noncardiac even frequently than cardiovascular heart-failure–related issues. Conclusions— The this study neutral. mortality risk surrogates well-being significantly. Quantitative assessment requirements suggested that besides (tele)monitoring individualized considering also should be integrated efforts achieve sustainable improvement outcomes. Clinical Trial Registration— URL: http://www.controlled-trials.com . Unique identifier: ISRCTN23325295.