Two-year outcome of a prospective, controlled study of a disease management programme for elderly patients with heart failure.
OBJECTIVE
Elderly heart failure patients are at high risk of events. Available studies and systematic reviews suggest that elderly patients benefit from disease management programmes (DMPs). However, important questions remain open, including the optimal follow-up intensity and duration and whether such interventions are cost-effective during long-term follow-up and in different healthcare systems. The aim of this study was to determine the long-term efficacy of a hybrid DMP in consecutive older outpatients.


METHODS
Intervention consisted in combined hospital-based (cardiologists and nurse-coordinators from two heart failure clinics) and home-based (patient's general practitioner visits) care. The components of the DMP were the following: discharge planning, education, therapy optimisation, improved communication, early attention to signs and symptoms. Intensive follow-up was based on scheduled hospital visits (starting within 14 days of discharge), nurse's phone call and home general practitioner visits.


RESULTS
A group of 173 patients aged > or =70 years (mean age 77 +/- 6 years, 48% women) was randomly assigned to DMP (n = 86) or usual care (n = 87). At 2-year follow-up, a 36% reduction in all-cause death and heart failure hospital admissions was observed in DMP vs. usual care. All-cause and heart failure admissions as well as the length of hospital stay were also reduced. DMP patients reported, compared to baseline, significant improvements in functional status, quality of life and beta-blocker prescription rate. The intervention was cost-effective with a mean saving of euro 982.04 per patient enrolled.


CONCLUSIONS
A hybrid DMP for elderly heart failure patients improves outcomes and is cost-effective over a long-term follow-up.
Del Sindaco
Donatella
D
Division of Cardiology, Cardiogeriatric Department, INRCA Institute of Care and Research, Rome, Italy. ddelsindaco@yahoo.it
Pulignano
Giovanni
G
Minardi
Giovanni
G
Apostoli
Antonella
A
Guerrieri
Luca
L
Rotoloni
Marina
M
Petri
Gabriella
G
Fabrizi
Lino
L
Caroselli
Attilia
A
Venusti
Rita
R
Chiantera
Angelo
A
Giulivi
Alessia
A
Giovannini
Ezio
E
Leggio
Francesco
F
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D010349:Patient Compliance; D010359:Patient Readmission; D015397:Program Evaluation; D011446:Prospective Studies; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D011788:Quality of Life; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome