Multidisciplinary network in heart failure management in a community-based population: Results and benefits at 2 years

Bonarek-Hessamfar, M.; Benchimol, Daniel; Lauribe, Ph.; Hadjo, A.; Matis, P; Dartigues, Jean François; Bonnet, Jonathan; Benchimol, H.

doi:10.1016/j.ijcard.2007.12.033

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…All five of the NRCTs were rated at high risk or unknown risk for most domains ( figure 2 A, B). 35–37 44 45 …”

Section: Resultsmentioning

confidence: 99%

“…Of the four community-initiated trials (two RCTs and two NRCTs) comparing admissions between CM with usual care, two reported no significant differences 38 43 and two reported statistically significant reductions in favour of CM. 44 45 One further trial compared CM, with telehealth and CM and reported no differences in admissions but data were not presented. 42…”

Section: Resultsmentioning

confidence: 99%

“…Of the four community-initiated trials comparing CM with usual care, two did not report LOS, 38 43 one reported median values in favour of CM 44 and the remaining one reported a mean reduction in LOS 45 ( table 2 ). The one comparative trial between community-initiated CM, and telehealth and CM did not report any useful data.…”

Section: Resultsmentioning

confidence: 99%

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Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

et al. 2016

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ObjectivesThe aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).SettingCM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.ParticipantsAdults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.InterventionCM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems.Primary and secondary outcomesPrimary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources.Results22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions.ConclusionsHospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.

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“…All five of the NRCTs were rated at high risk or unknown risk for most domains ( figure 2 A, B). 35–37 44 45 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

et al. 2016

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“…However, this study was conducted in a very particular setting and applied specific exclusion criteria limiting the generalizability of the results to the whole spectrum of patients managed in clinical practice (patients were included in medical centers for veterans and had no comorbidity associated with a predicted life expectancy ≤6 months). The 2nd published study, by Bonarek-Hessamfar et al, [26] included 362 patients (129 [36%] in HF-DMP group) with severe HF, with no indication for surgical or interventional treatment and no major disease reducing the short-term vital prognosis. After a 2-year follow-up period, the all-cause mortality was significantly lower in the HF-DMP group (HR 0.37, 0.16–0.89).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a multidisciplinary heart failure disease management programme on 1-year mortality

et al. 2016

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“…PCPs should also collaborate with other healthcare professionals as part of a multidisciplinary network of care because team approaches that include input from cardiologists, nurses, pharmacists, physical therapists, dietitians, and PCPs have been shown to improve patient survival, decrease readmission rates, and improve patient quality of life [ 90 , 91 ]. For example, Lee et al [ 92 ] found that collaboration between a PCP and a cardiologist within 30 days of a patient’s hospital discharge improved rates of follow-up testing, use of GDEM, and survival compared with PCP care alone.…”

Section: Areas For Improvement In the Treatment Of Hfmentioning

confidence: 99%

Stable but Progressive Nature of Heart Failure: Considerations for Primary Care Physicians

Anand

2018

Am J Cardiovasc Drugs

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Primary care physicians play a significant role in managing heart failure (HF), with the goals of reducing mortality, avoiding hospitalization, and improving patients’ quality of life. Most HF-related hospitalizations and deaths occur in patients with New York Heart Association functional class II or III, many of whom are perceived to have stable disease, which often progresses without clinical symptoms due to underlying deleterious effects of neurohormonal imbalance and endothelial dysfunction. Management includes lifestyle changes and stepped pharmacological therapy directed at the four stages of HF, with aggressive uptitration of therapies, including beta-blockers and inhibitors of the renin-angiotensin-aldosterone system. Recently, two new HF treatments have become available in clinical practice. Ivabradine was approved to reduce the risk of hospitalization for HF in patients with stable, symptomatic HF. Additionally, the angiotensin receptor–neprilysin inhibitor (ARNI), sacubitril/valsartan, was found to be significantly superior to enalapril in reducing risks of cardiovascular death and HF-related hospitalization. The respective 2016 and 2017 American College of Cardiology/American Heart Association/Heart Failure Society of America clinical practice guideline updates recommend that patients taking angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy be switched to ARNI therapy to further reduce morbidity and mortality. For HF management to be maximally effective, physicians must be knowledgeable about the risks and benefits of treatments and stay engaged with patients to identify signs of disease progression. This article provides an overview of the progressive nature of HF in apparently stable patients and describes areas for treatment improvement that may help to optimize patient care.

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Multidisciplinary network in heart failure management in a community-based population: Results and benefits at 2 years

Cited by 5 publications

References 14 publications

Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

Effectiveness of a multidisciplinary heart failure disease management programme on 1-year mortality

Stable but Progressive Nature of Heart Failure: Considerations for Primary Care Physicians

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