BACKGROUND: Despite the availability of proven therapies, outcomes in patients with heart failure (HF) remain poor. In this 2-stage, multicenter trial, we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF. METHODS AND RESULTS: In Stage 1, a pharmacist or nurse assessed each patient and made recommendations to the physician to add or adjust angiotensin-converting enzyme (ACE) inhibitors and other HF medications. Before discharge (Stage 2), patients were randomized to a patient support program (PSP) (education about HF, self-monitoring, adherence aids, newsletters, telephone hotline, and follow-up at 2 weeks, then monthly for 6 months after discharge) or usual care. In Stage 1 (766 patients) ACE inhibitor use increased from 58% on admission to 83% at discharge (P < .0001), and the daily dose (in enalapril equivalents) increased from 11.3 +/- 8.8 mg to 14.5 +/- 8.8 mg (P < .0001). In Stage 2 (276 patients) there was no difference in ACE inhibitor adherence, but a reduction in cardiovascular-related emergency room visits (49 versus 20, P = .030), hospitalization days (812 versus 341, P = .003), and cost of care (2,531 Canadian dollars less per patient) in favor of the PSP. CONCLUSION: Simple interventions can improve ACE inhibitor use and patient outcomes.
RCT Entities:
BACKGROUND: Despite the availability of proven therapies, outcomes in patients with heart failure (HF) remain poor. In this 2-stage, multicenter trial, we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF. METHODS AND RESULTS: In Stage 1, a pharmacist or nurse assessed each patient and made recommendations to the physician to add or adjust angiotensin-converting enzyme (ACE) inhibitors and other HF medications. Before discharge (Stage 2), patients were randomized to a patient support program (PSP) (education about HF, self-monitoring, adherence aids, newsletters, telephone hotline, and follow-up at 2 weeks, then monthly for 6 months after discharge) or usual care. In Stage 1 (766 patients) ACE inhibitor use increased from 58% on admission to 83% at discharge (P < .0001), and the daily dose (in enalapril equivalents) increased from 11.3 +/- 8.8 mg to 14.5 +/- 8.8 mg (P < .0001). In Stage 2 (276 patients) there was no difference in ACE inhibitor adherence, but a reduction in cardiovascular-related emergency room visits (49 versus 20, P = .030), hospitalization days (812 versus 341, P = .003), and cost of care (2,531 Canadian dollars less per patient) in favor of the PSP. CONCLUSION: Simple interventions can improve ACE inhibitor use and patient outcomes.
Authors: Hanneke W Drewes; Lotte M G Steuten; Lidwien C Lemmens; Caroline A Baan; Hendriek C Boshuizen; Arianne M J Elissen; Karin M M Lemmens; Jolanda A C Meeuwissen; Hubertus J M Vrijhoef Journal: Health Serv Res Date: 2012-03-14 Impact factor: 3.402
Authors: Sarah L Cutrona; Niteesh K Choudhry; Michael A Fischer; Amber Servi; Joshua N Liberman; Troyen A Brennan; William H Shrank Journal: Am J Manag Care Date: 2010 Impact factor: 2.229
Authors: Barbara Farrell; Lisa Dolovich; Phil Emberley; Marie-Anik Gagné; Brad Jennings; Derek Jorgenson; Natalie Kennie; Pia Zeni Marks; Christine Papoushek; Nancy Waite; Donna M M Woloschuk Journal: Can Pharm J (Ott) Date: 2012-07
Authors: Alison M Ward; Carl Heneghan; Rafael Perera; Dan Lasserson; David Nunan; David Mant; Paul Glasziou Journal: BMC Med Res Methodol Date: 2010-11-12 Impact factor: 4.615
Authors: Dean T Eurich; Ross T Tsuyuki; Sumit R Majumdar; Finlay A McAlister; Richard Lewanczuk; Marcelo C Shibata; Jeffrey A Johnson Journal: Trials Date: 2009-02-09 Impact factor: 2.279