[Impact of a nurse-based heart failure management program on hospitalization rate, functional status, quality of life, and medical costs].
BACKGROUND
Chronic heart failure is a major health problem for prevalence, morbidity and costs; heart failure management programs may prevent hospital admissions, improve clinical status and reduce medical costs.


METHODS
A care program for chronic heart failure patients was activated by the Cardiology Department, based on a nurse-monitored outpatient clinic, ran in cooperation with cardiologists, who were responsible for optimal pharmacological treatment. Nurses provided patient education, monitoring of clinical status and symptoms and verified adherence to pharmacologic and dietary therapy. To assess the impact of the program on hospitalization rate, functional status and quality of life we compared: 1) hospital admission rate for heart failure in the 6 months before and the 6 months after referral; 2) Minnesota Living with Heart Failure Questionnaire (MLHFQ) score and NYHA functional class at referral time and after 6 months. A cost-based analysis was performed to compare the two periods.


RESULTS
Between January 1999 and November 2000, 107 patients were followed up for at least 6 months. Hospitalization declined by 70% (57 admissions in the 6 months before referral, 17 in the 6 months afterwards, p = 0.0001). Functional status improved after 6 months: 41 patients were in NYHA class III-IV at referral time, 26 after 6 months. The mean total score of MLHFQ was reduced from 33.9 to 28.7 (p = 0.005). The average cost of the program was estimated to be [symbol: see text] 218 (Itl 423,000) per patient in 6 months. The savings in overall cost of care was [symbol: see text] 615 (Itl 1,192,000) per patient in 6 months.


CONCLUSIONS
A management program based on a nurse-monitored outpatient clinic can reduce hospitalization rate, improve functional status and quality of life and decrease medical costs for chronic heart failure patient's care.
Chinaglia
Alessandra
A
Dipartimento di Cardiologia, ASL 3, Azienda Ospedaliera San Giovanni Battista, Torino. chinaglia@onw.net
Gaschino
Gianni
G
Asteggiano
Riccardo
R
Titta
Giulio
G
Gullstrand
Ragnar
R
Bobbio
Marco
M
Trinchero
Rita
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009738:Nursing Service, Hospital / Q000191:economics; D015397:Program Evaluation; D013997:Time Factors
Fattibilità ed efficacia di un programma di assistenza integrata tra ospedale e territorio basata su un ambulatorio infermieristico nella gestione dei pazienti con scompenso cardiaco. Risultati clinici a sei mesi e costi relativi.