BACKGROUND: The effectiveness of heart failure disease management programs in patients under cardiologists' care over long-term follow-up is not established. METHODS AND RESULTS: We investigated the effects of a disease management program with repetitive education and telephone monitoring on primary (combined death or unplanned first hospitalization and quality-of-life changes) and secondary end points (hospitalization, death, and adherence). The REMADHE [Repetitive Education and Monitoring for ADherence for Heart Failure] trial is a long-term randomized, prospective, parallel trial designed to compare intervention with control. One hundred seventeen patients were randomized to usual care, and 233 to additional intervention. The mean follow-up was 2.47+/-1.75 years, with 54% adherence to the program. In the intervention group, the primary end point composite of death or unplanned hospitalization was reduced (hazard ratio, 0.64; confidence interval, 0.43 to 0.88; P=0.008), driven by reduction in hospitalization. The quality-of-life questionnaire score improved only in the intervention group (P<0.003). Mortality was similar in both groups. Number of hospitalizations (1.3+/-1.7 versus 0.8+/-1.3, P<0.0001), total hospital days during the follow-up (19.9+/-51 versus 11.1+/-24 days, P<0.0001), and the need for emergency visits (4.5+/-10.6 versus 1.6+/-2.4, P<0.0001) were lower in the intervention group. Beneficial effects were homogeneous for sex, race, diabetes and no diabetes, age, functional class, and etiology. CONCLUSIONS: For a longer follow-up period than in previous studies, this heart failure disease management program model of patients under the supervision of a cardiologist is associated with a reduction in unplanned hospitalization, a reduction of total hospital days, and a reduced need for emergency care, as well as improved quality of life, despite modest program adherence over time.
RCT Entities:
BACKGROUND: The effectiveness of heart failure disease management programs in patients under cardiologists' care over long-term follow-up is not established. METHODS AND RESULTS: We investigated the effects of a disease management program with repetitive education and telephone monitoring on primary (combined death or unplanned first hospitalization and quality-of-life changes) and secondary end points (hospitalization, death, and adherence). The REMADHE [Repetitive Education and Monitoring for ADherence for Heart Failure] trial is a long-term randomized, prospective, parallel trial designed to compare intervention with control. One hundred seventeen patients were randomized to usual care, and 233 to additional intervention. The mean follow-up was 2.47+/-1.75 years, with 54% adherence to the program. In the intervention group, the primary end point composite of death or unplanned hospitalization was reduced (hazard ratio, 0.64; confidence interval, 0.43 to 0.88; P=0.008), driven by reduction in hospitalization. The quality-of-life questionnaire score improved only in the intervention group (P<0.003). Mortality was similar in both groups. Number of hospitalizations (1.3+/-1.7 versus 0.8+/-1.3, P<0.0001), total hospital days during the follow-up (19.9+/-51 versus 11.1+/-24 days, P<0.0001), and the need for emergency visits (4.5+/-10.6 versus 1.6+/-2.4, P<0.0001) were lower in the intervention group. Beneficial effects were homogeneous for sex, race, diabetes and no diabetes, age, functional class, and etiology. CONCLUSIONS: For a longer follow-up period than in previous studies, this heart failure disease management program model of patients under the supervision of a cardiologist is associated with a reduction in unplanned hospitalization, a reduction of total hospital days, and a reduced need for emergency care, as well as improved quality of life, despite modest program adherence over time.
Authors: Jennifer L Kuntz; Monika M Safford; Jasvinder A Singh; Shobha Phansalkar; Sarah P Slight; Qoua Liang Her; Nancy Allen Lapointe; Robin Mathews; Emily O'Brien; William B Brinkman; Kevin Hommel; Kevin C Farmer; Elissa Klinger; Nivethietha Maniam; Heather J Sobko; Stacy C Bailey; Insook Cho; Maureen H Rumptz; Meredith L Vandermeer; Mark C Hornbrook Journal: Patient Educ Couns Date: 2014-09-16
Authors: Andrew Sherwood; Christopher M O'Connor; Faye S Routledge; Alan L Hinderliter; Lana L Watkins; Michael A Babyak; Gary G Koch; Kirkwood F Adams; Carla Sueta Dupree; Patricia P Chang; Benson M Hoffman; Julie Johnson; Margaret Bowers; Kristy S Johnson; James A Blumenthal Journal: J Card Fail Date: 2011-01-21 Impact factor: 5.712
Authors: Nini H Jonkman; Heleen Westland; Rolf H H Groenwold; Susanna Ågren; Manuel Anguita; Lynda Blue; Pieta W F Bruggink-André de la Porte; Darren A DeWalt; Paul L Hebert; Michele Heisler; Tiny Jaarsma; Gertrudis I J M Kempen; Marcia E Leventhal; Dirk J A Lok; Jan Mårtensson; Javier Muñiz; Haruka Otsu; Frank Peters-Klimm; Michael W Rich; Barbara Riegel; Anna Strömberg; Ross T Tsuyuki; Jaap C A Trappenburg; Marieke J Schuurmans; Arno W Hoes Journal: J Card Fail Date: 2016-06-30 Impact factor: 5.712
Authors: Silvia M Ayub-Ferreira; Sandrigo Mangini; Victor S Issa; Fátima D Cruz; Fernando Bacal; Guilherme V Guimarães; Paulo R Chizzola; Germano E Conceição-Souza; Fabiana G Marcondes-Braga; Edimar A Bocchi Journal: PLoS Negl Trop Dis Date: 2013-04-25