title: Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial.
abstract: BACKGROUND
  This trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure (HF) rehospitalization or death.
  
  
  RESULTS
  HF patients (n=198) were randomly assigned to standard care or standard care plus multidisciplinary group clinics. The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6, where multidisciplinary professionals engaged patients in HF self-management skills. Data were collected prospectively for 12 months beginning after completion of the first 4 group clinic appointments (2 months post randomization). The intervention was associated with greater adherence to recommended vasodilators (P=0.04). The primary outcome (first HF-related hospitalization or death) was experienced by 22 (24%) in the intervention group and 30 (28%) in standard care. The total HF-related hospitalizations, including repeat hospitalizations after the first time, were 28 in the intervention group and 45 among those receiving standard care. The effects of treatment on rehospitalization varied significantly over time. From 2 to 7 months post randomization, there was a significantly longer hospitalization-free time in the intervention group (Cox proportional hazard ratio=0.45 (95% confidence interval, 0.21-0.98; P=0.04). No significant difference between groups was found from month 8 to 12 (hazard ratio=1.7; 95% confidence interval, 0.7-4.1).
  
  
  CONCLUSIONS
  Multidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway. Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00439842.
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Ubolrat
authors.initials: U
authors.lastname: Piamjariyakul
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Jo A
authors.initials: JA
authors.lastname: Wick
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Christy
authors.initials: C
authors.lastname: Russell
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Dalton
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Elyachar
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: James L
authors.initials: JL
authors.lastname: Vacek
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Reeder
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Niaman
authors.initials: N
authors.lastname: Nazir
authors.affiliation: From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration*; D016016:Proportional Hazards Models; D012648:Self Care; D016896:Treatment Outcome
keywords: clinical trial; heart failure; survival analysis