Prospective evaluation of an outpatient heart failure management program

State of the Science

“…The frequency of cardiovascular hospitalizations and emergency department visits decreased, and QOL improved over time. 272 In a recent meta-analysis, programs that focused on enhancing patient self-care abilities reduced HF hospitalizations (relative risk 0.66, 95% CI 0.52 to 0.83) and all-cause hospitalizations (relative risk 0.73, 95% CI 0.57 to 0.93) but had no effect on mortality (relative risk 1.14, 95% CI 0.67 to 1.94). 273 Telehealth is a specific form of disease management that holds promise for improving the self-care abilities of persons with HF.…”

What Can a Pilot Congestive Heart Failure Disease Management Program Tell Us about Likely Return on Investment?: A Case Study from a Program Offered to Federal Employees

“…First, the pilot nature of our study resulted in a small sample of program participants (although the 457 participants included here are still greater in number than those reported in some other studies 20,22,23 ). Apparently this was more problematic for low-risk beneficiaries, causing the impact estimate for this group to be statistically insignificant (ie, p Ͼ 0.05; Table 2).…”

Bridging the gap between evidence and practice in acute decompensated heart failure management

“…Numerous evaluations have established the effectiveness of these programs in enhancing use of appropriate medications, improving functional status, reducing readmissions and mortality, and decreasing costs. [44][45][46][47][48][49][50][51][52][53][54] For example, in separate evaluations, the prevalences of appropriate vasodilator use (93% vs. 61%; P < .001), 51 b-blocker use (71% vs. 40%; P < .001), 50 and ACE inhibitor use (84% vs. 59%; P < .001) 52 were significantly greater for disease management program participants compared with nonparticipants. In addition, participation in a disease management program was associated with a 52% reduction in the risk of hospitalization for cardiovascular causes (P < .001) and a 72% reduction in ED visits (P < .01) in 1 evaluation, 45 a 36% reduction (95% CI: 16.7%-50.9%) in the risk of heart failure admission or death in another, 53 and a 67% reduction (95% CI: 41%-82%) in the adjusted risk of death in yet another evaluation.…”

“…Finally, they need to be cognizant of what constitutes appropriate exercise and the need for this exercise. [44][45][46][47] To enhance understanding and retention, this information should be presented to the patient over the course of the hospitalization. Comprehension should be tested continually and education repeated until appropriate understanding is ensured.…”