[A comprehensive management system for heart failure improves clinical outcomes and reduces medical resource utilization].
BACKGROUND
Hospital admissions for heart failure are common and readmission rates are high. Many admissions and readmissions may be avoidable, so that alternative strategies are needed to improve long-term management.


METHODS
We conducted a randomized trial of the effect of a guideline-based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized due to decompensated heart failure. The intervention consisted of comprehensive education of the patient and family, a prescribed diet and intensive application of guidelines' recommendations on pharmacological therapy. The intervention started before discharge and continued thereafter with follow-up visits for up to 3 months. Two hundred and nine guideline-managed patients were compared to 209 concurrent normally-discharged patients.


RESULTS
Patients in the study group were more prescribed beta-blockers, ACE-inhibitors, angiotensin receptor blockers, and spironolactone. Sixteen patients (8%) in the intervention group and 31 (15%) among controls were readmitted for DRG 127, within 3 months of discharge (Fisher's exact test, p < 0.01), while the 6-month mortality rate was similar between groups (9 and 11.5% respectively). Quality of life significantly improved from 5.6 +/- 1.0 to 6.1 +/- 1.9 (Mann-Whitney U-test, p < 0.05). The overall costs of care were lower for guideline-managed patients (110 vs 150 Euro per patient per month), due to the lower readmission rates.


CONCLUSIONS
Our study showed that a guideline-based management program for patients with heart failure at discharge improves quality of life and reduces readmission for DRG 127 and total bed days, allowing relevant cost savings.
Valle
Roberto
R
Ambulatorio per lo Scompenso Cardiaco, UO di Cardiologia, Ospedale Civile, San Donà di Piave, VE. robertovalle@libero.it
Carbonieri
Emanuele
E
Tenderini
Pierluigi
P
Zanella
Carlo
C
De Cian
Francesca
F
Ginocchio
Giuliana
G
Cannas
Sergio
S
Milan
Daniele
D
Milani
Loredano
L
D000368:Aged; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D016896:Treatment Outcome