title: Two-year outcome of a prospective, controlled study of a disease management programme for elderly patients with heart failure.
abstract: 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.
authors: Division of Cardiology, Cardiogeriatric Department, INRCA Institute of Care and Research, Rome, Italy. ddelsindaco@yahoo.it
authors: Donatella
authors: D
authors: Del Sindaco
authors: Giovanni
authors: G
authors: Pulignano
authors: Giovanni
authors: G
authors: Minardi
authors: Antonella
authors: A
authors: Apostoli
authors: Luca
authors: L
authors: Guerrieri
authors: Marina
authors: M
authors: Rotoloni
authors: Gabriella
authors: G
authors: Petri
authors: Lino
authors: L
authors: Fabrizi
authors: Attilia
authors: A
authors: Caroselli
authors: Rita
authors: R
authors: Venusti
authors: Angelo
authors: A
authors: Chiantera
authors: Alessia
authors: A
authors: Giulivi
authors: Ezio
authors: E
authors: Giovannini
authors: Francesco
authors: F
authors: Leggio
mesh_terms: 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