title: Disease management produces limited quality-of-life improvements in patients with congestive heart failure: evidence from a randomized trial in community-dwelling patients.
abstract: BACKGROUND
  Disease management programs are reported to improve clinical and quality-of-life outcomes while simultaneously lowering healthcare costs.
  
  
  OBJECTIVE
  To examine the effectiveness of disease management in improving health-related quality of life (HRQL) among patients with heart failure beyond 12 months.
  
  
  METHODS
  A total of 1069 community-dwelling patients 18 years and older in South Texas with echocardiographic evidence of congestive heart failure were randomly assigned to disease management, augmented disease management, and control groups. They were followed up 18 months. Patients in the control group received usual care. Patients in the intervention groups were assigned a registered nurse as a disease manager who performed telephonic patient education and medication management. Health-related quality-of-life data (based on the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were collected 4 times, at 6-month intervals.
  
  
  RESULTS
  Disease management has a limited effect on HRQL. Analysis of the SF-36 health transition measure showed a positive effect of the intervention on self-reported improvement in health at 6 months and at 12 months (P = .04 and P = .004, respectively). However, no effect of disease management was observed across any of the SF-36 components. Women and patients with diastolic heart failure had poorer HRQL scores.
  
  
  CONCLUSIONS
  Participation in disease management has little effect on HRQL outcomes in congestive heart failure. Beneficial effects on the SF-36 scale scores seen at 6 and 12 months were not sustained. Therefore, it is unclear whether disease management can provide long-term improvement in HRQL for patients with congestive heart failure.
authors.affiliation: Disease Management Center, The University of Texas Health Science Center at San Antonio, 4243 Piedras Drive East, Suite 240, San Antonio, TX 78228, USA. brad.smith@altarum.org
authors.forename: Brad
authors.initials: B
authors.lastname: Smith
authors.forename: Emma
authors.initials: E
authors.lastname: Forkner
authors.forename: Barbara
authors.initials: B
authors.lastname: Zaslow
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
authors.forename: Karl
authors.initials: K
authors.lastname: Stajduhar
authors.forename: Michael
authors.initials: M
authors.lastname: Kwan
authors.forename: Robert
authors.initials: R
authors.lastname: Ellis
authors.forename: Autumn Dawn
authors.initials: AD
authors.lastname: Galbreath
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Freeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013781:Texas