title: Effectiveness of a multidisciplinary heart failure disease management programme on 1-year mortality: Prospective cohort study.
abstract: We performed a multicenter prospective observational cohort study (Epidémiologie et Pronostic de l'Insuffisance Cardiaque Aiguë en Lorraine, Epidemiology and Prognosis of Acute Heart Failure in Lorraine [EPICAL2]) to evaluate the effectiveness on mortality of a community-based multidisciplinary disease management programme (DMP) for heart failure (HF) patients.Between October 2011 and October 2012, 1816 patients, who were hospitalized for acute HF or who developed acute HF during a hospitalization, were included from 21 hospitals in a northeast region of France. At hospital admission, their mean age was 77.3 (standard deviation [SD] 11.6) years and mean left ventricular ejection fraction was 45.0 (SD 16.0)%. A subset of patients were enrolled in a multidimensional DMP for HF (n = 312, 17.2%), based on structured patient education, home monitoring visits by HF-trained nurses, and automatic alerts triggered by significant clinical and biological changes to the patient. The DMP involved general practitioners, nurses, and cardiologists collaborating via an individual web-based medical electronic record. The outcome was all-cause mortality from the 3rd to the 12th month after discharge. During the follow-up, a total of 377 (20.8%) patients died: 321 (21.3%) in the control group and 56 (17.9%) in the DMP group. In a propensity score analysis, DMP was associated with lower 1-year all-cause mortality (hazard ratio 0.65, 95% CI 0.46-0.92). Instrumental variable analysis gave similar results (hazard ratio 0.56, 0.27-1.16).In a real world setting, a multidimensional DMP for HF with structured patient education, home nurse monitoring, and appropriate physician alerts may improve survival when implemented after discharge from hospitalization due to worsening HF.
authors.affiliation: University of Lorraine, APEMAC EA4360 Inserm U1116, CIC-P 1433, University Hospital of Nancy, Nancy F-CRIN INI-CRCT network Inserm U942 University Paris Diderot, Sorbonne Paris Cité Department of Anesthesia and Critical Care, Hôpitaux Universitaires Saint-Louis Lariboisière, APHP, Paris Inserm CIC-EC 6, Clinical Epidemiology and Evaluation, University Hospital of Nancy, Nancy, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Laborde-Castérot
authors.forename: Nelly
authors.initials: N
authors.lastname: Agrinier
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.forename: Nathalie
authors.initials: N
authors.lastname: Thilly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis