title: Home-based disease management program to improve psychological status in patients with heart failure in Japan.
abstract: BACKGROUND
  A disease management program can reduce mortality and rehospitalization of patients with heart failure (HF), but little is known about whether it can improve psychological status. The purpose of this study was to determine the effects of home-based disease management on the psychological status of patients with HF.
  
  
  RESULTS
  We randomly assigned patients hospitalized for HF to undergo either home-based disease management (n=79) or usual care (n=82). The mean age of the study patients was 76 years, 30% were female, and 93% were in NYHA class I or II. Home-based disease management was delivered by nurses via home visit and telephone follow-up to monitor symptoms and body weight and to educate patients. The primary endpoint was psychological status, including depression and anxiety assessed by the Hospital Anxiety and Depression Scale during follow-up of 1 year. Secondary endpoints included quality of life, all-cause death and hospitalization for HF. The intervention group had significantly lower depression (P=0.043) and anxiety (P=0.029) scores than the usual-care group. There were no significant differences in all-cause death [hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.37-2.61, P=0.967]. However, hospitalization for HF was significantly lower in the intervention group than in the usual-care group (HR 0.52, 95% CI 0.27-0.96, P=0.037).
  
  
  CONCLUSIONS
  Home-based disease management improved psychological status and also reduced rehospitalization for HF in patients with HF.
authors.affiliation: School of Nursing, Kitasato University, Sagamihara, Japan. miyuki_t@cardiol.med.kyushu-u.ac.jp
authors.forename: Miyuki
authors.initials: M
authors.lastname: Tsuchihashi-Makaya
authors.forename: Hisashi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Shigeo
authors.initials: S
authors.lastname: Kakinoki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takechi
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kinugawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006760:Hospitalization; D006792:House Calls; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009726:Nurses; D010353:Patient Education as Topic; D012648:Self Care / Q000379:methods*