title: Lack of improvement of clinical outcomes by a low-cost, hospital-based heart failure management programme.
abstract: OBJECTIVE
  Heart failure (HF) is a major health problem resulting in a high financial burden for the healthcare system. Many previous HF management programmes reduced adverse clinical outcomes and costs, but they usually involved several professional figures as well as huge investments, requiring resources and budgets not often available in our healthcare system. We evaluated the effects of our HF management programme, which included patient education and regular outpatient contact with the HF team, on re-hospitalisation and death, optimising the few resources already available at our hospital.
  
  
  METHODS
  Two hundred consecutive patients admitted to the internal medicine department with a diagnosis of HF were randomised to the intervention group (nurse-led education programme, facilitated telephone communication and follow-up visits with an internist at 15 days, 1 and 6 months) or to the usual care group (follow-up by their primary care physician). The primary endpoints were all-cause readmissions and all-cause deaths during the 6-month post-discharge period.
  
  
  RESULTS
  There were 81 all-cause hospital readmissions in the intervention group and 82 in the control group (P = NS). Fourteen patients (14%) in the intervention group and eight patients (8%) in the control group died during the study period (P = NS). Unplanned outpatient visits were less frequent in the intervention group than in the control group (39 [28%] versus 99 [72%], P < 0.001).
  
  
  CONCLUSIONS
  The present low-cost HF management programme reduced unplanned outpatient visits but proved ineffective in reducing subsequent readmissions and in improving clinical status. More intense follow-up monitoring and more resources are needed to achieve better results.
authors.affiliation: Cardiology Unit, Cardiopulmonary Science Department, S. Maria della Misericordia Hospital, Udine, Italy. gnucifora@cardionet.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Nucifora
authors.forename: Maria Cecilia
authors.initials: MC
authors.lastname: Albanese
authors.forename: Paola
authors.initials: P
authors.lastname: De Biaggio
authors.forename: Donato
authors.initials: D
authors.lastname: Caliandro
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.forename: Paolo
authors.initials: P
authors.lastname: Goss
authors.forename: Daniela
authors.initials: D
authors.lastname: Miani
authors.forename: Claudio
authors.initials: C
authors.lastname: Fresco
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bulfoni
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Fioretti
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D016009:Chi-Square Distribution; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D011788:Quality of Life; D016019:Survival Analysis; D013689:Telephone