Two-year outcome of a prospective, controlled study of a disease management programme for elderly patients with heart failure

Sindaco, Donatella Del; Pulignano, Giovanni; Minardi, Giovanni; Apostoli, A.; Guerrieri, Luca; Rotoloni, Marina; Petri, Gabriella; Fabrizi, Lino; Caroselli, A.; Venusti, Rita; A, Chiantera; Giulivi, Alessia; Giovannini, E; Leggio, F

doi:10.2459/jcm.0b013e32801164cb

Cited by 102 publications

(122 citation statements)

References 26 publications

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“…Data from smaller (single-and two-centre) studies (128)(129)(130)(131)) demonstrated a significant reduction in hospitalization and a trend toward a reduction in mortality. A larger study (428 patients) by Cleland et al (132) examining home telemonitoring (HTM) compared with either nurse telephone support (NTS) or usual care found that there was no statistically significant difference between groups for the number of days lost as a result of death or hospitalization.…”

Section: Acute Decompensated Hf During Pregnancymentioning

confidence: 98%

“…Whether a DMP is a cost-effective way to manage these patients is not well established. The studies suggest a DMP may be cost effective or the extra cost associated with a DMP is acceptable (131,(139)(140)(141)(142). In a recent analysis by Whellan et al (143), an interesting concept based on the American system of reimbursement is presented.…”

Section: Acute Decompensated Hf During Pregnancymentioning

confidence: 99%

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The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

100

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Section: Acute Decompensated Hf During Pregnancymentioning

confidence: 98%

Section: Acute Decompensated Hf During Pregnancymentioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

100

View full text Add to dashboard Cite

“…The Singapore population has, however, heterogeneous ethnic origins and their study enrolled 56% Chinese, 26% Malay and 17% Indian patients. 21 In terms of clinical outcomes, the effect of 24 which showed that disease management led to a lower admission rate (RR 0.253; 95% CI 0.065, 0.403; P = 0.014). In The Netherlands, the Deventer-Alkmaar heart failure study found an association between disease management and lower heart failure-related admissions and allcause deaths (RR 0.49; 95% CI 0.30, 0.81; P = 0.001).…”

Section: Y-h Chen Y-l Ho H-c Huang Et Al Chinese Home-based Intervmentioning

confidence: 99%

Assessment of the Clinical Outcomes and Cost-Effectiveness of the Management of Systolic Heart Failure in Chinese Patients Using a Home-Based Intervention

Chen

Huang

et al. 2010

J Int Med Res

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This study was designed to assess the clinical effect of a home-based telephone intervention in Chinese heart failure patients. A total of 550 Chinese heart failure patients were enrolled into either (i) a group that received the usual standard of care (UC group); or (ii) a group that received a home-based heart failure centre management programme using nursing specialist-led telephone consultations (HFC group). The impact of the home-based intervention on admission rate, admission length and medical costs over 6 months was measured. Although the mean left ventricular ejection fraction in HFC patients was 29.3% compared with 34.8% in UC patients, the home-based intervention resulted in a significantly lower all-cause admission rate per person (HFC 0.60 ± 0.77 times/person; UC 0.96 ± 0.85 times/person), a shorter all-cause hospital stay (reduced by 8 days per person) and lower total 6-month medical costs (reduced by US$2682 per patient). These results suggest that the home-based intervention with nursing specialist-led telephone consultations may improve the clinical outcome and provide cost-savings for Chinese patients with heart failure.

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“…The meta-analysis showed a significant reduc- Reasons for exclusion: duplicates; editorials; letters; comments; reviews; protocols without data, without an intervention; not on transition, transition within hospitals, to nursing home, within specialist services; from emergency to the hospital; emergency conditions; education/health promotion; speci c intervention (eg, medication prescription only) 5 trials identied through the screening of reference lists 41 included in the systematic review * References 35,37,38,41,[44][45][46][47]50,54,55,57,60,67,68,73 T …”

Section: Effect On All-cause Hospital Readmissionmentioning

confidence: 99%

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

Vedel

Khanassov

2015

The Annals of Family Medicine

104

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PURPOSE We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration. METHODSWe conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration. RESULTSWe identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87-0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51-0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious. CONCLUSIONS Clinicians and managers who implement TCIs in primary carecan incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option. INTRODUCTIONC ongestive heart failure (CHF) imposes an increasingly heavy burden on health care systems, most of which can be attributed to numerous hospital readmissions and emergency department (ED) visits. [1][2][3] Multiple exacerbations of CHF result in frequent use of acute health care services by these patients, known as revolving door users. After discharge, 25% of patients are readmitted within the first 30 days, 4,5 and 50% within the first 6 months. 6,7 This frequent use of health care services is mainly due to lack of understanding of a treatment plan, nonadherence to medical therapy, unawareness of CHF symptom exacerbation, and irregular follow-up. [8][9][10][11][12] Lack of coordination and communication between hospitalists and primary care physicians (PCPs) has been documented. 13,14 PCPs too often do not receive discharge summaries, 15 and when they do receive them, the summaries often lack appropriate documentation of medication indication and advice for follow-up. It is therefore difficult for PCPs to plan an appropriate follow-up after hospital discharge. 16To address these issues, transitional care interventions (TCIs) have been implemented with a common objective of reducing the rate of hos- 563pital readmis...

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Two-year outcome of a prospective, controlled study of a disease management programme for elderly patients with heart failure

Abstract: A hybrid DMP for elderly heart failure patients improves outcomes and is cost-effective over a long-term follow-up.

Cited by 102 publications

References 26 publications

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Assessment of the Clinical Outcomes and Cost-Effectiveness of the Management of Systolic Heart Failure in Chinese Patients Using a Home-Based Intervention

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

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