Prospective evaluation of an outpatient heart failure disease management program designed for primary care: the Oregon model.
BACKGROUND
Most heart failure care is provided by primary care providers. Although heart failure disease management programs improve outcomes, most have been hospital-based with little integration with primary care providers. To address this issue, a heart failure clinic disease management model was adapted for use in the primary care setting.


RESULTS
A heart failure clinic staffed by 2 internists and their nurses was established in a large primary care practice. Medical care and pharmacotherapy were based on national guidelines. Nurses assisted with disease management. Primary outcomes included quality of life, functional class, and all-cause hospital and emergency room admissions 12 months before compared with 12 months after enrollment; a secondary endpoint was patient satisfaction. Of 165 patients sent to the heart failure clinic, 54 were referred back because of no active heart failure, and 18 had only 1 clinic visit. The 93 patients seen 2 or more times had a median age of 75 years. Anti-angiotensin II therapy was present in 84% and did not change over time, but doses of angiotensin-converting enzyme inhibitor increased by >50%. beta-blocker use increased from 40% at baseline to 63% at 6 months. Emergency room visits or all-cause hospitalizations were reduced (0.86 +/- 1.5 to 0.52 +/- 0.86, P < .001) or trended to be reduced (0.56 +/- 0.98 to 0.35 +/- 0.62, P = .07), respectively, by approximately 40%. Quality of life improved significantly at all time points, and patients were highly satisfied.


CONCLUSIONS
This heart failure disease management model, designed for patients and providers in an primary care setting, was feasible and successful.
Hershberger
Ray E
RE
The Oregon Heart Failure Project, Department of Medicine/Cardiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Nauman
Deirdre J
DJ
Byrkit
James
J
Gillespie
Gordon
G
Lackides
Greg
G
Toy
Warren
W
Burgess
Donna
D
Dutton
Diana
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000451:nursing / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D017060:Patient Satisfaction; D010865:Pilot Projects; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors