CLINCAL STUDY
Randomized trial of an education and support intervention to preventreadmission of patients with heart failure
Harlan M. Krumholz, MD, FACC*   ,*,
Joan Amatruda, RN,
Grace L. Smith, MPH,
Jennifer A. Mattera, MPH,
Sarah A. Roumanis, RN,
Martha J. Radford, MD, FACC*,
Paula Crombie, LCSW|| and
Viola Vaccarino, MD, PhD¶
* Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
Qualidigm®, Middletown, Connecticut, USA
Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
|| Yale-New Haven Hospital, New Haven, Connecticut, USA
¶ Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USAAt the time this work was conducted, Dr. Vaccarino was affiliated with the Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
Manuscript received November 30, 2000;
revised manuscript received September 17, 2001,
accepted September 20, 2001.
* Reprint requests and correspondence: Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, Connecticut, USA 06520-8025.
OBJECTIVES: We determined the effect of a targeted education and support intervention on the rate of readmission or death and hospital costs in patients with heart failure (HF).
BACKGROUND: Disease management programs for patients with HF including medical components may reduce readmissions by 40% or more, but the value of an intervention focused on education and support is not known.
METHODS: We conducted a prospective, randomized trial of a formal education and support intervention on one-year readmission or mortality and costs of care for patients hospitalized with HF.
RESULTS: Among the 88 patients (44 intervention and 44 control) in the study, 25 patients (56.8%) in the intervention group and 36 patients (81.8%) in the control group had at least one readmission or died during one-year follow-up (relative risk = 0.69, 95% confidence interval [CI]: 0.52, 0.92; p = 0.01). The intervention was associated with a 39% decrease in the total number of readmissions (intervention group: 49 readmissions; control group: 80 readmissions, p = 0.06). After adjusting for clinical and demographic characteristics, the intervention group had a significantly lower risk of readmission compared with the control group (hazard ratio = 0.56, 95% CI: 0.32, 0.96; p = 0.03) and hospital readmission costs of $7,515 less per patient.
CONCLUSIONS: A formal education and support intervention substantially reduced adverse clinical outcomes and costs for patients with HF.
|
Abbreviations and Acronyms
| | CI | | confidence interval | | CVD | | cardiovascular disease | | HF | | heart failure | | HR | | hazard ratio | | RR | | relative risk | | YNHH | | Yale-New Haven Hospital |
|
This article has been cited by other articles:
|
|
|
|
 
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur. Heart J.,
October 1, 2008;
29(19):
2388 - 2442.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. S. Keenan, S.-L. T. Normand, Z. Lin, E. E. Drye, K. R. Bhat, J. S. Ross, J. D. Schuur, B. D. Stauffer, S. M. Bernheim, A. J. Epstein, et al.
An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure
Circ Cardiovasc Qual Outcomes,
September 1, 2008;
1(1):
29 - 37.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Antonicelli, P. Testarmata, L. Spazzafumo, C. Gagliardi, G. Bilo, M. Valentini, F. Olivieri, and G. Parati
Impact of telemonitoring at home on the management of elderly patients with congestive heart failure
J Telemed Telecare,
September 1, 2008;
14(6):
300 - 305.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Ross, G. K. Mulvey, B. Stauffer, V. Patlolla, S. M. Bernheim, P. S. Keenan, and H. M. Krumholz
Statistical Models and Patient Predictors of Readmission for Heart Failure: A Systematic Review
Arch Intern Med,
July 14, 2008;
168(13):
1371 - 1386.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. C. Wang, A. P. Maggioni, M. A. Konstam, F. Zannad, H. B. Krasa, J. C. Burnett Jr, L. Grinfeld, K. Swedberg, J. E. Udelson, T. Cook, et al.
Clinical Implications of QRS Duration in Patients Hospitalized With Worsening Heart Failure and Reduced Left Ventricular Ejection Fraction
JAMA,
June 11, 2008;
299(22):
2656 - 2666.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Paul
Hospital Discharge Education for Patients With Heart Failure: What Really Works and What Is the Evidence?
Crit. Care Nurse,
April 1, 2008;
28(2):
66 - 82.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Jaarsma, M. H. L. van der Wal, I. Lesman-Leegte, M.-L. Luttik, J. Hogenhuis, N. J. Veeger, R. Sanderman, A. W. Hoes, W. H. van Gilst, D. J. A. Lok, et al.
Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)
Arch Intern Med,
February 11, 2008;
168(3):
316 - 324.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W F B.-A. de la Porte, D. J A Lok, D. J van Veldhuisen, J. van Wijngaarden, J. H Cornel, N. P A Zuithoff, E. Badings, and A. W Hoes
Added value of a physician-and-nurse-directed heart failure clinic: results from the Deventer-Alkmaar heart failure study
Heart,
July 1, 2007;
93(7):
819 - 825.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. A Schiffer, J. Denollet, J. W Widdershoven, E. H Hendriks, and O. R F Smith
Failure to consult for symptoms of heart failure in patients with a type-D personality
Heart,
July 1, 2007;
93(7):
814 - 818.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Coons and T. Fera
Multidisciplinary team for enhancing care for patients with acute myocardial infarction or heart failure
Am. J. Health Syst. Pharm.,
June 15, 2007;
64(12):
1274 - 1278.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. O Grancelli and D. C Ferrante
Telephone interventions for disease management in heart failure
BMJ,
May 5, 2007;
334(7600):
910 - 911.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Elhendy, J M Tsutsui, E L O'Leary, F Xie, F Majeed, and T R Porter
Evaluation of restenosis and extent of coronary artery disease in patients with previous percutaneous coronary interventions by dobutamine stress real-time myocardial contrast perfusion imaging
Heart,
October 1, 2006;
92(10):
1480 - 1483.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Krumholz, P. M. Currie, B. Riegel, C. O. Phillips, E. D. Peterson, R. Smith, C. W. Yancy, and D. P. Faxon
A Taxonomy for Disease Management: A Scientific Statement From the American Heart Association Disease Management Taxonomy Writing Group
Circulation,
September 26, 2006;
114(13):
1432 - 1445.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S.F. Yu, D. R. Thompson, and D. T.F. Lee
Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes
Eur. Heart J.,
March 1, 2006;
27(5):
596 - 612.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. W. Stevenson, T. H. Le Jemtel, E. U. Alt, L. W. Stevenson, T. H. Le Jemtel, and E. U. Alt
Hemodynamic Goals Are Relevant
Circulation,
February 21, 2006;
113(7):
1020 - 1033.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Sud, E. M Kline-Rogers, K. A Eagle, J. Fang, D. F Armstrong, K. Rangarajan, R. F Otten, D. R Stafkey-Mailey, S. D Taylor, and S. R Erickson
Adherence to Medications by Patients After Acute Coronary Syndromes
Ann. Pharmacother.,
November 1, 2005;
39(11):
1792 - 1797.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Rustoen, J. Howie, I. Eidsmo, and T. Moum
Hope in Patients Hospitalized With Heart Failure
Am. J. Crit. Care.,
September 1, 2005;
14(5):
417 - 425.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Daly, S. L. Douglas, C. G. Kelley, E. O'Toole, and H. Montenegro
Trial of a Disease Management Program to Reduce Hospital Readmissions of the Chronically Critically Ill
Chest,
August 1, 2005;
128(2):
507 - 517.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R Holland, J Battersby, I Harvey, E Lenaghan, J Smith, and L Hay
Systematic review of multidisciplinary interventions in heart failure
Heart,
July 1, 2005;
91(7):
899 - 906.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. M. Koelling, M. L. Johnson, R. J. Cody, and K. D. Aaronson
Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure
Circulation,
January 18, 2005;
111(2):
179 - 185.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. C. Fonarow
Heart Failure Disease Management Programs: Not a Class Effect
Circulation,
December 7, 2004;
110(23):
3506 - 3508.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. D. Galbreath, R. A. Krasuski, B. Smith, K. C. Stajduhar, M. D. Kwan, R. Ellis, and G. L. Freeman
Long-Term Healthcare and Cost Outcomes of Disease Management in a Large, Randomized, Community-Based Population With Heart Failure
Circulation,
December 7, 2004;
110(23):
3518 - 3526.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Kimmelstiel, D. Levine, K. Perry, A. R. Patel, A. Sadaniantz, N. Gorham, M. Cunnie, L. Duggan, L. Cotter, P. Shea-Albright, et al.
Randomized, Controlled Evaluation of Short- and Long-Term Benefits of Heart Failure Disease Management Within a Diverse Provider Network: The SPAN-CHF Trial
Circulation,
September 14, 2004;
110(11):
1450 - 1455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gonseth, P. Guallar-Castillon, J. R. Banegas, and F. Rodriguez-Artalejo
The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports
Eur. Heart J.,
September 2, 2004;
25(18):
1570 - 1595.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Gustafsson and J. M. O. Arnold
Heart failure clinics and outpatient management: review of the evidence and call for quality assurance
Eur. Heart J.,
September 2, 2004;
25(18):
1596 - 1604.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Mejhert, T Kahan, H Persson, and M Edner
Limited long term effects of a management programme for heart failure
Heart,
September 1, 2004;
90(9):
1010 - 1015.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A. McAlister, S. Stewart, S. Ferrua, and J. J.J.V. McMurray
Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials
J. Am. Coll. Cardiol.,
August 18, 2004;
44(4):
810 - 819.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Riegel, M. Naylor, S. Stewart, J. J. V. McMurray, and M. W. Rich
Interventions to Prevent Readmission for Congestive Heart Failure
JAMA,
June 16, 2004;
291(23):
2816 - 2816.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. O. Phillips, S. M. Wright, D. E. Kern, H. R. Rubin, and S. Shepperd
Interventions to Prevent Readmission for Congestive Heart Failure--Reply
JAMA,
June 16, 2004;
291(23):
2816 - 2817.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. P. Faxon, L. H. Schwamm, R. C. Pasternak, E. D. Peterson, B. J. McNeil, V. Bufalino, C. W. Yancy, L. M. Brass, D. W. Baker, R. O. Bonow, et al.
Improving Quality of Care Through Disease Management: Principles and Recommendations From the American Heart Association's Expert Panel on Disease Management
Stroke,
June 1, 2004;
35(6):
1527 - 1530.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. P. Faxon, L. H. Schwamm, R. C. Pasternak, E. D. Peterson, B. J. McNeil, V. Bufalino, C. W. Yancy, L. M. Brass, D. W. Baker, R. O. Bonow, et al.
Improving Quality of Care Through Disease Management: Principles and Recommendations From the American Heart Association's Expert Panel on Disease Management
Circulation,
June 1, 2004;
109(21):
2651 - 2654.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Z. Pantilat and A. E. Steimle
Palliative Care for Patients With Heart Failure
JAMA,
May 26, 2004;
291(20):
2476 - 2482.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Johnson and B. Cujec
Reply
J. Am. Coll. Cardiol.,
April 7, 2004;
43(7):
1333 - 1334.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. O. Phillips, S. M. Wright, D. E. Kern, R. M. Singa, S. Shepperd, and H. R. Rubin
Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart Failure: A Meta-analysis
JAMA,
March 17, 2004;
291(11):
1358 - 1367.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Johnson, Y. Jin, H. Quan, and B. Cujec
Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada
J. Am. Coll. Cardiol.,
October 15, 2003;
42(8):
1438 - 1445.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A Masoudi and H. M Krumholz
Polypharmacy and comorbidity in heart failure
BMJ,
September 6, 2003;
327(7414):
513 - 514.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H. Kim and S. A. Hunt
Heart Failure Management: Caregiver Versus Care Plan
Circulation,
July 15, 2003;
108(2):
129 - 131.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. B. Ferguson Jr, E. D. Peterson, L. P. Coombs, M. C. Eiken, M. L. Carey, F. L. Grover, and E. R. DeLong
Use of Continuous Quality Improvement to Increase Use of Process Measures in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial
JAMA,
July 2, 2003;
290(1):
49 - 56.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Jaarsma and D. J. van Veldhuisen
The optimal "dose" of disease management programs in HF
J. Am. Coll. Cardiol.,
June 19, 2002;
39(12):
2080 - 2081.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. K. Moser and D. L. Mann
Improving Outcomes in Heart Failure: It's Not Unusual Beyond Usual Care
Circulation,
June 18, 2002;
105(24):
2810 - 2812.
[Full Text]
[PDF]
|
|
|
|
