title: Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: does more equal less?
abstract: OBJECTIVE
  To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS).
  
  
  BACKGROUND
  The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes.
  
  
  METHODS
  Prospective cohort study of patients participating in heart failure programmes.
  
  
  METHODS
  Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined.
  
  
  RESULTS
  Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer.
  
  
  CONCLUSIONS
  High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months.
  
  
  CONCLUSIONS
  The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.
authors: Faculty of Health, School of Nursing and Midwifery, Deakin University & Austin Health, Melbourne, Vic., Australia. andrea.driscoll@deakin.edu.au
authors: Andrea
authors: A
authors: Driscoll
authors: Andrew
authors: A
authors: Tonkin
authors: Andrew
authors: A
authors: Stewart
authors: Linda
authors: L
authors: Worrall-Carter
authors: David R
authors: DR
authors: Thompson
authors: Barbara
authors: B
authors: Riegel
authors: David L
authors: DL
authors: Hare
authors: Patricia M
authors: PM
authors: Davidson
authors: Christine
authors: C
authors: Mulvany
authors: Simon
authors: S
authors: Stewart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries