Quan L Huynh1, Kristyn Whitmore2, Kazuaki Negishi2, Thomas H Marwick3. 1. Baker Heart and Diabetes Institute, Melbourne, Australia. 2. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. 3. Baker Heart and Diabetes Institute, Melbourne, Australia. Electronic address: tom.marwick@baker.edu.au.
Abstract
OBJECTIVE: Disease management programs (DMPs) may reduce short-term readmission or death after heart failure (HF) hospitalization. We sought to determine if targeting of DMP to the highest-risk patients could improve efficiency. METHODS AND RESULTS:Patients (n = 412) admitted with HF were randomized to usual care or an intensive DMP including optimizing intravascular volume status at discharge, increased self-care education, exercise guidance, closer home surveillance, and increased intensity of HF nurse follow-up. Both treatment groups were similar in demographics, medication use, Charlson comorbidity index, ejection fraction, and left ventricular and atrial volumes. Readmission or death occurred in 74/197 (37%) usual care and 50/215 (23%) DMP patients within 30 days (relative risk [RR] 0.62, 95% confidence interval [CI] 0.46-0.84), and 113/197 (57%) usual care and 78/215 (36%) DMP patients within 90 days, (RR 0.63, 9%% CI 0.51-0.78). The predicted risk of death and readmission (estimated from our previously developed risk score) was similar between treatment groups (mean predicted risk 38.6 ± 22.2% vs 39.4 ± 21.9%; P = .73) and similar across categories of predicted risk between the treatment groups. For 30-day readmission or death, patients from the 2 highest risk quintiles showed a benefit from intervention, and there was an interaction between intervention and predicted risk (P = .02). For 90-day readmission or death, most patients-other than those in the lowest-risk quintile-benefited from the intervention. CONCLUSIONS: Use of a risk score may permit targeting of DMP to reduce HF admission. Intensive DMP may reduce short-term readmission or death, particularly in high-risk patients.
RCT Entities:
OBJECTIVE: Disease management programs (DMPs) may reduce short-term readmission or death after heart failure (HF) hospitalization. We sought to determine if targeting of DMP to the highest-risk patients could improve efficiency. METHODS AND RESULTS:Patients (n = 412) admitted with HF were randomized to usual care or an intensive DMP including optimizing intravascular volume status at discharge, increased self-care education, exercise guidance, closer home surveillance, and increased intensity of HF nurse follow-up. Both treatment groups were similar in demographics, medication use, Charlson comorbidity index, ejection fraction, and left ventricular and atrial volumes. Readmission or death occurred in 74/197 (37%) usual care and 50/215 (23%) DMPpatients within 30 days (relative risk [RR] 0.62, 95% confidence interval [CI] 0.46-0.84), and 113/197 (57%) usual care and 78/215 (36%) DMPpatients within 90 days, (RR 0.63, 9%% CI 0.51-0.78). The predicted risk of death and readmission (estimated from our previously developed risk score) was similar between treatment groups (mean predicted risk 38.6 ± 22.2% vs 39.4 ± 21.9%; P = .73) and similar across categories of predicted risk between the treatment groups. For 30-day readmission or death, patients from the 2 highest risk quintiles showed a benefit from intervention, and there was an interaction between intervention and predicted risk (P = .02). For 90-day readmission or death, most patients-other than those in the lowest-risk quintile-benefited from the intervention. CONCLUSIONS: Use of a risk score may permit targeting of DMP to reduce HF admission. Intensive DMP may reduce short-term readmission or death, particularly in high-risk patients.
Authors: Yee Yin Hoo; Wardati Mazlan-Kepli; Wan Nurul Huda Wan Hasan; Fan Jie Chen; Prashanthini Devadas; Yan Yee Chow; Qian Yi Sow; Azrol Amar Azizan; Abdul Muizz Abd Malek; Glendon Seng Kiong Lau; Ping Lik Chua Journal: J Saudi Heart Assoc Date: 2020-12-03
Authors: Georgios Zisis; Quan Huynh; Yang Yang; Christopher Neil; Melinda J Carrington; Jocasta Ball; Graeme Maguire; Thomas H Marwick Journal: ESC Heart Fail Date: 2020-07-22