title: Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study.
abstract: BACKGROUND
  Trials investigating efficacy of disease management programs (DMP) in heart failure reported contradictory results. Features rendering specific interventions successful are often ill defined. We evaluated the mode of action and effects of a nurse-coordinated DMP (HeartNetCare-HF, HNC).
  
  
  RESULTS
  Patients hospitalized for systolic heart failure were randomly assigned to HNC or usual care (UC). Besides telephone-based monitoring and education, HNC addressed individual problems raised by patients, pursued networking of health care providers and provided training for caregivers. End points were time to death or rehospitalization (combined primary), heart failure symptoms, and quality of life (SF-36). Of 1007 consecutive patients, 715 were randomly assigned (HNC: n=352; UC: n=363; age, 69±12 years; 29% female; 40% New York Heart Association class III-IV). Within 180 days, 130 HNC and 137 UC patients reached the primary end point (hazard ratio, 1.02; 95% confidence interval, 0.81-1.30; P=0.89), since more HNC patients were readmitted. Overall, 32 HNC and 52 UC patients died (1 UC patient and 4 HNC patients after dropout); thus, uncensored hazard ratio was 0.62 (0.40-0.96; P=0.03). HNC patients improved more regarding New York Heart Association class (P=0.05), physical functioning (P=0.03), and physical health component (P=0.03). Except for HNC, health care utilization was comparable between groups. However, HNC patients requested counseling for noncardiac problems even more frequently than for cardiovascular or heart-failure-related issues.
  
  
  CONCLUSIONS
  The primary end point of this study was neutral. However, mortality risk and surrogates of well-being improved significantly. Quantitative assessment of patient requirements suggested that besides (tele)monitoring individualized care considering also noncardiac problems should be integrated in efforts to achieve more sustainable improvement in heart failure outcomes.
  
  
  BACKGROUND
  URL: http://www.controlled-trials.com. Unique identifier: ISRCTN23325295.
authors.affiliation: Department of Internal Medicine I, University Hospital Würzburg, Germany. angermann_c@klinik.uni-wuerzburg.de
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Angermann
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Hermann
authors.initials: H
authors.lastname: Faller
authors.forename: Roland
authors.initials: R
authors.lastname: Jahns
authors.forename: Stefan
authors.initials: S
authors.lastname: Frantz
authors.forename: Markus
authors.initials: M
authors.lastname: Loeffler
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D054143:Heart Failure, Systolic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome