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.
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Abbreviations and Acronyms
| | CI | | confidence interval | | CVD | | cardiovascular disease | | HF | | heart failure | | HR | | hazard ratio | | RR | | relative risk | | YNHH | | Yale-New Haven Hospital |
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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]
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T. Jaarsma
Heart failure management programs: how far should we go?
Eur J Heart Fail,
June 1, 2003;
5(3):
215 - 216.
[Full Text]
[PDF]
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T. Jaarsma, A. Stromberg, J. Martensson, and K. Dracup
Development and testing of the European Heart Failure Self-Care Behaviour Scale
Eur J Heart Fail,
June 1, 2003;
5(3):
363 - 370.
[Abstract]
[Full Text]
[PDF]
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S.P. Wright, H. Walsh, K.M. Ingley, S.A. Muncaster, G.D. Gamble, A. Pearl, G.A. Whalley, N. Sharpe, and R.N. Doughty
Uptake of self-management strategies in a heart failure management programme
Eur J Heart Fail,
June 1, 2003;
5(3):
371 - 380.
[Abstract]
[Full Text]
[PDF]
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C. Cline
Nurse-led clinics for heart failure in Sweden--doing the right thing?
Eur J Heart Fail,
August 1, 2002;
4(4):
393 - 394.
[Full Text]
[PDF]
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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]
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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]
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