Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: the SPAN-CHF trial.
BACKGROUND
Several trials support the usefulness of disease management (DM) for improving clinical outcomes in heart failure (HF). Most of these studies are limited by small sample size; absence of concurrent, randomized controls; limited follow-up; restriction to urban academic centers; and low baseline use of effective medications.


RESULTS
We performed a prospective, randomized assessment of the effectiveness of HF DM delivered for 90 days across a diverse provider network in a heterogeneous population of 200 patients with high baseline use of approved HF pharmacotherapy. During a 90-day follow-up, patients randomized to DM experienced fewer hospitalizations for HF [primary end point, 0.55+/-0.15 per patient-year alive versus 1.14+/-0.22 per patient-year alive in control subjects; relative risk (RR), 0.48, P=0.027]. Intervention patients experienced reductions in hospital days related to a primary diagnosis of HF (4.3+/-0.4 versus 7.8+/-0.6 days hospitalized per patient-year; RR, 0.54; P<0.001), cardiovascular hospitalizations (0.81+/-0.19 versus 1.43+/-0.24 per patient-year alive; RR, 0.57; P=0.043), and days in hospital per patient-year alive for cardiovascular cause (RR, 0.64; P<0.001). Intervention patients showed a trend toward reduced all-cause hospitalizations and total hospital days. On long-term (mean, 283 days) follow-up, there was substantial attrition of the 3-month gain in outcomes, with sustained significant reduction only in days in hospital for cardiac cause.


CONCLUSIONS
In a population with high background use of standard HF therapy, a DM intervention, uniformly delivered across varied clinical sites, produced significant short-term improvement in HF-related clinical outcomes. Longer-term benefit likely requires more active chronic intervention, even among patients who appear clinically stable.
Division of Cardiology, Tufts-New England Medical Center, and Tufts University School of Medicine, Boston, Mass 02111, USA.
Carey
C
Kimmelstiel
Daniel
D
Levine
Kathleen
K
Perry
Ayan R
AR
Patel
Ara
A
Sadaniantz
Noreen
N
Gorham
Margaret
M
Cunnie
Lynne
L
Duggan
Linda
L
Cotter
Patricia
P
Shea-Albright
Athena
A
Poppas
Kenneth
K
LaBresh
Daniel
D
Forman
David
D
Brill
William
W
Rand
Douglas
D
Gregory
James E
JE
Udelson
Beverly
B
Lorell
Varda
V
Konstam
Kathleen
K
Furlong
Marvin A
MA
Konstam
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D002309:Cardiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017028:Caregivers / Q000193:education; D015897:Comorbidity; D004039:Diet, Sodium-Restricted; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000178:diet therapy / Q000188:drug therapy / Q000453:epidemiology / Q000451:nursing*; D006760:Hospitalization / Q000706:statistics & numerical data; D006764:Hospitals, Community; D006792:House Calls; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D011331:Private Practice; D012237:Rhode Island / Q000453:epidemiology; D012648:Self Care; D012720:Severity of Illness Index; D016037:Single-Blind Method
D002317:Cardiovascular Agents