Predictors of dropout from a multidisciplinary heart failure program: a nested case study.
BACKGROUND
Chronic heart failure is a growing public health issue that is reaching epidemic proportions. In the last few years, multidisciplinary management programs have been developed to improve its management. Yet, some patients take advantage of these programs, whereas others do not.


METHODS
Several demographic, medical, and social variables were evaluated as contributors to dropout after enrollment into a multidisciplinary heart failure program using a nested case-control design. A total of 14 patients and 42 controls were interviewed using a standardized questionnaire. Possible associations were explored by means of chi Mantel-Haenszel test and a binary logistic regression model.


RESULTS
The only significant factor associated with dropout was social isolation. Patients who lived alone, without family support, had a significantly greater dropout risk (odds ratio, 12.5; 95% confidence interval, 1.35-11.6).


CONCLUSIONS
For patients who live alone, an individualized approach may be better than a multidisciplinary management program, but this hypothesis should be investigated in future studies.
Clinical Department of Medicine, Hospital de Clinicas de Montevideo, Uruguay. dralvar@adinet.com.uy
Pablo
P
Alvarez Rocha
Gabriela
G
Ormaechea
Jorge
J
Pouso
Ignacio
I
Batista
Virginia
V
Estrago
Paola
P
Fernández
Lucia
L
Florio
Lidia
L
Icasuriaga
Patricia
P
Muñiz
Virginia
V
Ortiz
Gabriel
G
Parma
Roberto
R
Ricca
Luz T
LT
Rios
Gabriela
G
Silvera
Fernando
F
Kuster
Alfredo Alvarez
AA
Rocha
Ricardo
R
Lluberas
D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts; D012307:Risk Factors; D016037:Single-Blind Method; D012934:Social Isolation; D012944:Social Support; D014583:Uruguay