A new programme of multidisciplinary care for patients with heart failure in Poznań: one-year follow-up.
BACKGROUND
Recent trials have demonstrated the effectiveness of multidisciplinary care (MDC) for patients with chronic heart failure (CHF). However, results of the assessment of different programmes in individual countries could be different because of local specificities of health care systems.


OBJECTIVE
We sought to determine whether MDC for patients with CHF has an influence on mortality, rate of rehospitalisation, quality of life (QoL) and self-care (SC) during a one-year study period.


METHODS
160 patients with CHF treated in our unit were randomly assigned to receive either MDC or routine care (RC). Patients from the MDC group (n=80; mean age 67+/-10.2 years) attended follow-up visits at the heart failure clinic after 14 days and 3, 6, 9 and 12 months after discharge. They were cared for by a team which consisted of a cardiologist, a heart failure nurse (HF nurse), a psychologist and a physiotherapist. This group of patients received comprehensive education from the HF nurse and the cardiologist. Telephone counselling and home-based interventions by the HF nurse were also available daily. Patients from the RC group (n=80, mean age 69.5+/-10.7 years) were cared for by their primary care physician only. In both groups QoL and SC scores were calculated based on a 21 and 12-item questionnaire completed by the patients at discharge and after one year.


RESULTS
After one-year follow-up the two groups did not differ in terms of either total and HF mortality or number of sudden deaths. In the MDC group when compared to the RC group we observed a significant decrease in the total number of hospital readmissions (by 37%, p <0.05), a decrease in hospital admissions due to HF (by 48%; p <0.05) and decreased length of stay during both all-cause readmissions and those due to HF (p <0.05). After one year of follow-up both QoL and SC scores were significantly lower in the MDC group than in the RC group (p <0.001), indicating improved QoL in the MDC group.


CONCLUSIONS
The one-year multidisciplinary care programme for patients with chronic heart failure in Poznań demonstrated significant improvement of treatment results in terms of frequency of readmissions and length of hospital stay as well as improved Qol. A tendency to decreased total and heart failure related mortality and decreased number of sudden deaths was also observed.
Wierzchowiecki
Michał
M
II Klinika Kardiologii, Szpital im. F. Raszei, ul. Mickiewicza 2, 60-834 Poznań. kardio2@am.poznan.pl
Poprawski
Kajetan
K
Nowicka
Anna
A
Kandziora
Magdalena
M
Piatkowska
Anna
A
Jankowiak
Maciej
M
Michałowicz
Barbara
B
Stawski
Włodzimierz
W
Dziamska
Małgorzata
M
Kaszuba
Dorota
D
Szymanowska
Katarzyna
K
Michalski
Marek
M
D000368:Aged; D003695:Delivery of Health Care; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D016896:Treatment Outcome