title: Factors Associated With Inadequate Effectiveness of a Multidisciplinary Disease Management Program in Heart Failure Patients Stratified by Galectin 3 Level.
abstract: OBJECTIVE
  This study investigated whether multidisciplinary disease management programs (MDPs) exert the same effects in heart failure (HF) patients across risk levels stratified by galectin-3 (Gal-3) level and what factors are associated with inadequate effectiveness of MDP.
  
  
  METHODS
  We used a longitudinal follow-up design based on a previous randomized trial. A total of 355 stabilized hospitalized HF patients were enrolled. The effects of MDP on death and HF-related rehospitalization were analyzed according to Gal-3 levels.
  
  
  RESULTS
  During the 4-year follow-up, Gal-3 levels predicted mortality and composite events ( p < .001). Multivariable analysis demonstrated the event-lowering effect of MDP (hazard ratio [HR] = 0.49, p = .001 for death and HR = 0.50, p < .001 for composite events). However, the effect of MDP was inadequate for those with high Gal-3 levels (≥17.9 ng/ml), whose 4-year composite event rate was 43% in the MDP arm. Further analysis showed that, in patients with Gal-3 ≥ 17.9 ng/ml, the independent factors associated with a high composite event rate were no MDP, older age, worse New York Heart Association functional class, no angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, higher predischarge natriuretic peptide levels, and wider QRS complexes.
  
  
  CONCLUSIONS
  The effectiveness of MDP for HF patients at high risk was inadequate. Our findings identified the characteristics of these MDP nonresponders. Better integration of advanced care plans based on strategies guided by Gal-3 level is needed to improve care quality.
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.|2 Chang Gung University College of Medicine, Taoyuan, Taiwan.|3 Department of Nursing, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Min-Hui
authors.initials: MH
authors.lastname: Liu
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.|2 Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Wang
authors.affiliation: 3 Department of Nursing, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ai-Fu
authors.initials: AF
authors.lastname: Chiou
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.|2 Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ning-I
authors.initials: NI
authors.lastname: Yang
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.|2 Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Li-Tang
authors.initials: LT
authors.lastname: Kuo
keywords: disease management; galectin-3; heart failure; prognosis