Short‐ and long‐term results of a programme for the prevention of readmissions and mortality in patients with heart failure: Are effects maintained after stopping the programme?

Abstract

The objective of the study was to evaluate whether improvements obtained during an intervention programme were maintained after the programme was stopped. 153 patients discharged with a diagnosis of heart failure (HF) were randomized to either usual care or an intervention programme, which included patient education, consultation with the cardiologist and monitoring in the Heart Failure Unit. After an average period of 16 T 8 months, the intervention programme was stopped. One year later, all the patients were re-examined to assess HF readmissions, all-cause mortality, quality of life, and prescribed medical treatment. During the 16 T 8-month treatment period, patients in the intervention group had a lower rate of HF readmissions (17% vs. 51%, p < 0.01), less all-cause mortality (13% vs. 27%, p = 0.03), improvement in quality of life (1.5 T 0.8 vs. 1.9 T 1, p = 0.03) and optimisation of medical treatment was achieved. One year after stopping the intervention, there was no difference in HF readmissions (28% vs. 25%, p = 0.72), all-cause mortality (14% vs. 17%, p = 0.64) and quality of life (1.7 T 0.9 vs. 1.8 T 1, p = 0.24) between the groups. Survival and the probability of not being readmitted due to HF were similar in both groups. There was also a reduction in the use of beta-blockers and spironolactone in the intervention group. Conclusions: The positive effects of an intervention programme are clearly reduced when it is stopped, due to less strict control of the patients and a decrease in the use of drugs with proven efficacy in HF.

Long-Term Prospective, Randomized, Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients

“…The hypothesis that adherence would be monitored in long-term follow-up as an additional mechanism to prevent the reduction in late positive effects is attractive. 38 Also, the intervention has no underlying psychosocial theory but was designed with methods of support that have worked well in these medical settings.…”

Extending the Horizon in Chronic Heart Failure

“…Clearly, as part of a formal CHF management program, there would be mechanisms to actively reintervene and/or provide more appropriate palliative support. 13 Certainly, recent data from a CHF management program in Spain 30 suggesting that the initial, positive impact of a clinic-based multidisciplinary intervention in CHF was attenuated at 12 months after cessation of active management reinforces the need to monitor health outcomes and reintervene when necessary, particularly when there are no mechanisms for further community-based intervention. A United States-based study employing an intervention similar to our own (but perhaps more CHF-specific) demonstrating shortterm (90-day) but not longer-term (mean, 283 days) benefits also contrasts with our data.…”

Mechanisms of Disease: detrimental adrenergic signaling in acute decompensated heart failure

“…at least 3-6 months, preferably years) of β-blockers is essential for functional changes and a survival benefit to be seen. 15 Following receptor activation, second-messenger-dependent protein kinases, including cyclic-AMP-dependent protein kinase (PKA), phosphorylate serine and threonine residues within the cytoplasmic loops and C-terminal-tail domains of the βARs. Phosphorylation of these sites is sufficient to impair receptor-G-protein coupling.…”