Efficacy of multidisciplinary outpatient management (MOM) program in long term heart failure care.
BACKGROUND
Heart failure (HF) management programs worldwide have reported conflicting outcomes in the past.


OBJECTIVE
We sought to determine retrospectively whether the multidisciplinary outpatient management (MOM) program [heart failure clinic (HFC)], decreased readmission rates (RR), duration of hospital stay, and/or mortality in HF patients.


METHODS
Records of 138 HF patients who had their first encounter either as admission for HF at St. Agnes Hospital or visit to HFC during the period June 2005 through June 2006 were evaluated for outcomes through September 2007. Twenty-seven patients were followed in the HFC and 111 were in the non-HFC group. During follow up, 39 of the non-HFC group patients crossed over to the HFC group. All baseline parameters, except age (P = 0.006), were similar in both groups.


RESULTS
In the HFC group 4 patients had a total of 5 readmissions, whereas 85 patients had a total of 187 readmissions (P < 0.001) in the non-HFC group. Average lengths of hospitalization were 5.2 +/- 4.8 days and 4.2 +/- 3.2 days (P = 0.18) and the number of readmissions/patient/year was 0.3 and 1.45 (P < 0.001) in the HFC and non-HFC groups, respectively. In the subgroup analysis of cross overs (n = 39), there was a 60% reduction in the readmission rate after crossing over to the HFC group. The significance of decreased mortality in the HFC group could not be assessed due to the small sample size.


CONCLUSIONS
The study suggests that the MOM program can significantly reduce RR secondary to HF.
Jain
Rahul
R
Division of Cardiology, Saint Agnes Hospital, Baltimore, MD, USA. rjain7@jhmi.edu
Evenson
Ariana
A
Jain
Rohit
R
Biddison
Elizabeth
E
Dalal
Darshan
D
Kelly
Kathleen M
KM
Karmand
Arezo J
AJ
Hullsiek
Heide
H
Punnam
Jyothi
J
Plantholt
Stephen
S
D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome