The benefit of implementing a heart failure disease management program.
BACKGROUND
To handle the increasing complexity of congestive heart failure (CHF) care, several new models for the care of patients with CHF have been developed to replace traditional strategies. We undertook this study to evaluate the potential benefit of implementing a CHF disease management program at a tertiary care center, particularly in terms of beta-blocker use and cost to the health care system.


METHODS
After reviewing the literature regarding therapies and management strategies for patients with CHF, we developed the Duke Heart Failure Program. All enrolled patients had 1 of the following: recent CHF hospitalization, ejection fraction less than 20%, or symptoms consistent with New York Heart Association class III or IV. We compared preenrollment and postenrollment medication use and resource utilization.


RESULTS
We enrolled 117 patients from July 1998 to April 1999. Mean enrollment time was 4.7 months. beta-Blocker use and dose significantly increased (52% vs 76% for beta-blocker, P<.01; 6% vs 13% of target dose, P<.01). The hospitalization rate decreased (1.5 vs 0 hospitalizations per patient-year, P<.01), while the number of clinic visits increased (4.3 vs 9.8 clinic visits per patient-year, P<.01). The Duke University Health System saved a median of $8571 per patient-year.


CONCLUSIONS
Implementing a CHF disease management program was associated with improved CHF medication dosing and with decreased hospitalization for patients with CHF. A CHF disease management program is an effective method for a health care system to care for patients with CHF.
Whellan
D J
DJ
Division of Cardiology, Department of Medicine, Box 3356, Duke University Medical Center, Durham, NC 27710, USA. whell001@mc.duke.edu
Gaulden
L
L
Gattis
W A
WA
Granger
B
B
Russell
S D
SD
Blazing
M A
MA
Cuffe
M S
MS
O'Connor
C M
CM
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005260:Female; D006284:Health Plan Implementation / Q000191:economics*; D006333:Heart Failure / Q000191:economics* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D009657:North Carolina; D010359:Patient Readmission / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D014600:Utilization Review
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors