title: Effect of multidisciplinary disease management for hospitalized heart failure under a national health insurance programme.
abstract: OBJECTIVE
  Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be effective in Western countries. However, it is not known whether they improve outcomes in a high population density country with a national health insurance programme.
  
  
  METHODS
  In total, 349 patients hospitalized because of heart failure were randomized into control and MDP groups. All-cause death and re-hospitalization related to heart failure were analyzed. The median follow-up period was approximately 2 years.
  
  
  RESULTS
  Mean patient age was 60 years; 31% were women; and 50% of patients had coronary artery disease. MDP was associated with fewer all-cause deaths [hazard ratio (HR) = 0.49, 95% confidence interval (CI) = 0.27-0.91, P = 0.02] and heart failure-related re-hospitalizations (HR = 0.44, 95% CI = 0.25-0.77, P = 0.004). MDP was still associated with better outcomes for all-cause death (HR = 0.53, 95% CI = 0.29-0.98, P = 0.04) and heart failure-related re-hospitalization (HR = 0.46, 95% CI = 0.26-0.81, P = 0.007), after adjusting for age, diuretics, diabetes mellitus, chronic kidney disease, hypertension, sodium, and albumin. However, MDPs' effect on all-cause mortality and heart failure-related re-hospitalization was significantly attenuated after adjusting for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or β-blockers. A stratified analysis showed that MDP combined with guideline-based medication had synergistic effects.
  
  
  CONCLUSIONS
  MDP is effective in lowering all-cause mortality and re-hospitalization rates related to heart failure under a national health insurance programme. MDP synergistically improves the effectiveness of guidelines-based medications for heart failure.
authors.affiliation: aDepartment of Internal Medicine, Division of Cardiology, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan bDepartment of Nursing, National Yang-Ming University, Taipei, Taiwan cDepartment of Healthcare Management, Laboratory for Epidemiology, Chang Gung University College dHealthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chun-Tai
authors.initials: CT
authors.lastname: Mao
authors.forename: Min-Hui
authors.initials: MH
authors.lastname: Liu
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
authors.forename: Tieh-Cheng
authors.initials: TC
authors.lastname: Fu
authors.forename: Jong-Shyan
authors.initials: JS
authors.lastname: Wang
authors.forename: Yu-Yen
authors.initials: YY
authors.lastname: Huang
authors.forename: Ning-I
authors.initials: NI
authors.lastname: Yang
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Wang
mesh_terms: D000368:Aged; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data; D013624:Taiwan / Q000453:epidemiology