Short- and long-term results of a programme for the prevention of readmissions and mortality in patients with heart failure: are effects maintained after stopping the programme?
The objective of the study was to evaluate whether improvements obtained during an intervention programme were maintained after the programme was stopped. 153 patients discharged with a diagnosis of heart failure (HF) were randomized to either usual care or an intervention programme, which included patient education, consultation with the cardiologist and monitoring in the Heart Failure Unit. After an average period of 16+/-8 months, the intervention programme was stopped. One year later, all the patients were re-examined to assess HF readmissions, all-cause mortality, quality of life, and prescribed medical treatment. During the 16+/-8-month treatment period, patients in the intervention group had a lower rate of HF readmissions (17% vs. 51%, p<0.01), less all-cause mortality (13% vs. 27%, p=0.03), improvement in quality of life (1.5+/-0.8 vs. 1.9+/-1, p=0.03) and optimisation of medical treatment was achieved. One year after stopping the intervention, there was no difference in HF readmissions (28% vs. 25%, p=0.72), all-cause mortality (14% vs. 17%, p=0.64) and quality of life (1.7+/-0.9 vs. 1.8+/-1, p=0.24) between the groups. Survival and the probability of not being readmitted due to HF were similar in both groups. There was also a reduction in the use of beta-blockers and spironolactone in the intervention group.


CONCLUSIONS
The positive effects of an intervention programme are clearly reduced when it is stopped, due to less strict control of the patients and a decrease in the use of drugs with proven efficacy in HF.
Ojeda
Soledad
S
Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain. sojeda@supercable.es
Anguita
Manuel
M
Delgado
Mónica
M
Atienza
Felipe
F
Rus
Carmen
C
Granados
Amador L
AL
Ridocci
Federico
F
Vallés
Federico
F
Velasco
Jose A
JA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D013030:Spain; D013148:Spironolactone / Q000627:therapeutic use; D016019:Survival Analysis
D000319:Adrenergic beta-Antagonists; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone