A multicenter disease management program for hospitalized patients with heart failure.
BACKGROUND
Despite the availability of proven therapies, outcomes in patients with heart failure (HF) remain poor. In this 2-stage, multicenter trial, we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF.


RESULTS
In Stage 1, a pharmacist or nurse assessed each patient and made recommendations to the physician to add or adjust angiotensin-converting enzyme (ACE) inhibitors and other HF medications. Before discharge (Stage 2), patients were randomized to a patient support program (PSP) (education about HF, self-monitoring, adherence aids, newsletters, telephone hotline, and follow-up at 2 weeks, then monthly for 6 months after discharge) or usual care. In Stage 1 (766 patients) ACE inhibitor use increased from 58% on admission to 83% at discharge (P < .0001), and the daily dose (in enalapril equivalents) increased from 11.3 +/- 8.8 mg to 14.5 +/- 8.8 mg (P < .0001). In Stage 2 (276 patients) there was no difference in ACE inhibitor adherence, but a reduction in cardiovascular-related emergency room visits (49 versus 20, P = .030), hospitalization days (812 versus 341, P = .003), and cost of care (2,531 Canadian dollars less per patient) in favor of the PSP.


CONCLUSIONS
Simple interventions can improve ACE inhibitor use and patient outcomes.
Tsuyuki
Ross T
RT
Division of Cardiology and Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 220 College Plaza, Edmonton, Canada T6G 2C8.
Fradette
Miriam
M
Johnson
Jeffrey A
JA
Bungard
Tammy J
TJ
Eurich
Dean T
DT
Ashton
Thomas
T
Gordon
Wendy
W
Ikuta
Roland
R
Kornder
Jan
J
Mackay
Elizabeth
E
Manyari
Dante
D
O'Reilly
Ken
K
Semchuk
William
W
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002170:Canada; D003376:Counseling; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients / Q000193:education / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance; D010353:Patient Education as Topic
D000806:Angiotensin-Converting Enzyme Inhibitors