title: Improved outcomes from a comprehensive management system for heart failure.
abstract: OBJECTIVE
  Congestive heart failure (CHF) is associated with a high readmission rate after diagnosis. We assessed the ability of a comprehensive management program (CMP) for CHF to reduce readmissions with secondary endpoints of improving quality of life, exercise capacity and targeted drug doses.
  
  
  RESULTS
  Patients (pts) with: New York Heart Association Class (NYHA) III or IV CHF; left ventricular ejection fraction <40%; and stable outpatient therapy were assigned to a CMP of cardiology assessment intensive education and referral to a tailored exercise program. Forty-two pts (35 M, 7 F, mean age 54 years, S.D. 12 years) were enrolled. Two pts were transplanted, two died during follow-up and two were lost to follow-up. Hospital admissions were reduced by 87.2%, (mean 1.05, S.D. 0.98, admissions per pt to mean 0.08, S.D. 0.28, admissions per pt at 6-month follow-up; P<0.0001). ACE-inhibitor dose increased by 42% (P<0.0008) and beta-blocker dose increased by 61% (P<0.0001). NYHA Class, 6-min walk and quality of life scores all improved significantly (P<0.0001).
  
  
  CONCLUSIONS
  A CMP improves QOL and exercise capacity as well as substantially reducing hospital admissions in CHF pts. This study validates the benefit of intensive outpatient care of CHF.
authors.affiliation: Cardiovascular Medicine, Heart Centre, Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria 3181, Australia. d.holst@alfred.org.au
authors.forename: D P
authors.initials: DP
authors.lastname: Holst
authors.forename: D
authors.initials: D
authors.lastname: Kaye
authors.forename: M
authors.initials: M
authors.lastname: Richardson
authors.forename: H
authors.initials: H
authors.lastname: Krum
authors.forename: D
authors.initials: D
authors.lastname: Prior
authors.forename: A
authors.initials: A
authors.lastname: Aggarwal
authors.forename: R
authors.initials: R
authors.lastname: Wolfe
authors.forename: P
authors.initials: P
authors.lastname: Bergin
mesh_terms: D000368:Aged; D002908:Chronic Disease; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index