Improving care for patients with chronic heart failure in the community: the importance of a disease management program.
OBJECTIVE
Utilizing a comparison group of patients with congestive heart failure (CHF) discharged to their primary care physicians, we sought to determine if disease management in a short-term, aggressive-intervention heart failure clinic (HFC) following hospital discharge is associated with improved outcomes.


METHODS
Chart review.


METHODS
An integrated health-care center serving a tristate area.


METHODS
Inclusion criteria were discharge from the hospital with a primary diagnosis of CHF, outpatient follow-up within the hospital system, and the presence of left ventricular systolic dysfunction as the basis for CHF. Patients were categorized into group 1 if they were referred to the HFC after hospital discharge, and into group 2 if follow-up care was provided by their primary care physician.


RESULTS
There were 38 patients in group 1 and 63 patients in group 2. There was a trend toward a shorter time to the first outpatient visit following discharge (11 days vs 15 days, p = 0.09), more outpatient visits within 90 days (10 visits vs 2 visits, p < 0.001), and more patient-initiated contacts (four contacts vs one contact, p = < 0.001) in group 1 compared to group 2, respectively. The combined hospital readmission and mortality rate at 90 days (10% vs 30%, p < 0.018) and 1 year (21% vs 43%, p < 0.02) was lower in group 1. There was a 77% relative risk reduction for 30-day hospital readmission in favor of group 1, and a statistically lower rate of readmissions at 90 days and 1 year. Utilization and maintenance of standardized CHF medications were significantly higher in patients who attended the HFC.


CONCLUSIONS
A comprehensive disease management program for patients discharged with a diagnosis of CHF resulted in fewer rehospitalizations and improved event-free survival compared to patients followed up by their primary care physicians.
Akosah
Kwame O
KO
Gundersen Lutheran Medical Foundation, La Crosse, WI 54601, USA. kakosah@gundluth.org
Schaper
Ana M
AM
Havlik
Paul
P
Barnhart
Sharon
S
Devine
Stephen
S
D000368:Aged; D000553:Ambulatory Care; D002908:Chronic Disease; D003191:Comprehensive Health Care; D019033:Delivery of Health Care, Integrated; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D015996:Survival Rate; D014922:Wisconsin