CLINICAL STUDY: HEART FAILURE
A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission
Edward K. Kasper, MD, FACC*,*,
Gary Gerstenblith, MD, FACC*,
Gail Hefter, CRNP*,
Elizabeth Van Anden, PA-C*,
Jeffrey A. Brinker, MD, FACC*,
David R. Thiemann, MD*,
Michael Terrin, MD ,
Sandra Forman, MA and
Sheldon H. Gottlieb, MD, FACC*
* Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Maryland Medical Research Institute, Baltimore, Maryland, USA
Manuscript received June 14, 2001;
revised manuscript received October 10, 2001,
accepted October 31, 2001.
* Reprint requests and correspondence: Dr. Edward K. Kasper, Division of Cardiology, Carnegie 568, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287-6568, USA.
ekasper{at}jhmi.edu
OBJECTIVES: We sought to determine whether a multidisciplinary outpatient management program decreases chronic heart failure (CHF) hospital readmissions and mortality over a six-month period.
BACKGROUND: Hospital admission for CHF is an important problem amenable to improved outpatient management.
METHODS: Two hundred patients hospitalized with CHF at increased risk of hospital readmission were randomized to a multidisciplinary program or usual care. A study cardiologist and a CHF nurse evaluated each patient and made recommendations to the patient’s primary physician before randomization. The intervention team consisted of a cardiologist, a CHF nurse, a telephone nurse coordinator and the patient’s primary physician. Contact with the patient was on a prespecified schedule. The CHF nurse followed an algorithm to adjust medications. Patients in the nonintervention group were followed as usual. The primary outcome was the composite of the number of CHF hospital admissions and deaths over six months, compared by using a log transformation t test by intention-to-treat analysis.
RESULTS: The median age of the study patients was 63.5 years, and 39.5% were women. There were 43 CHF hospital admissions and 7 deaths in the intervention group, as compared with 59 CHF hospital admissions and 13 deaths in the nonintervention group (p = 0.09). The quality-of-life score, percentage of patients on target vasodilator therapy and percentage of patients compliant with diet recommendations were significantly better in the intervention group. Cost per patient, in 1998 U.S. dollars, was similar in both groups.
CONCLUSIONS: This study demonstrates that a six-month, multidisciplinary approach to CHF management can improve important clinical outcomes at a similar cost in recently hospitalized high-risk patients with CHF.
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Abbreviations and Acronyms
| | NYHA | | ACE | | angiotensin-converting enzyme | | CHF | | chronic heart failure | | LV | | left ventricular | | LVEF | | left ventricular ejection fraction | | NYHA | | New York Heart Association |
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