Efficacy of community-based multidisciplinary disease management of chronic heart failure.
BACKGROUND
A multidisciplinary disease management (DM) programme in chronic heart failure (CHF) improves clinical outcome. The efficacy of such a programme in a heterogeneous Asian community is not well established. Therefore, we undertook the evaluation of the efficacy of the multidisciplinary community-based DM CHF programme.


METHODS
This was a prospective study involving 154 patients (54 percent male) with a primary diagnosis of CHF, New York Heart Association functional class III/IV CHF, with left ventricular ejection fraction (LVEF) less than 40 percent. The mean age was 65 +/- 12 years and mean LVEF was 27 +/- 9 percent. We evaluated CHF hospitalisation, quality of life, activity status and quality of care (percentage of patients who received ACE inhibitors/angiotensin receptor blockers (ARB) and beta blockers after a period of six months.


RESULTS
At six months, there was improvement in the quality of life and activity status (p < 0.001). ACE inhibitors/ARB were maintained in 97 percent of the patients and there was an increased usage of beta blockers (p-value equals 0.001). The rate of CHF hospitalisation was reduced by 68 percent (p-value is less than 0.001) and there was no mortality.


CONCLUSIONS
The multidisciplinary DM of CHF in a heterogeneous Asian community showed significant improvement in quality of life, quality of care and reduction in CHF hospitalisation.
Omar
A R
AR
Department of Cardiology, National University Hospital, Singapore. abdul_razakjr_bin_omar@nuh.com.sg
Suppiah
N
N
Chai
P
P
Chan
Y H
YH
Seow
Y H
YH
Quek
L L
LL
Poh
K K
KK
Tan
H C
HC
D000368:Aged; D002303:Cardiac Output, Low / Q000145:classification / Q000208:ethnology / Q000628:therapy*; D017028:Caregivers / Q000193:education; D019090:Case Management; D019468:Disease Management; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D012846:Singapore; D013689:Telephone; D016896:Treatment Outcome