HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (22) Citing Articles via Google Scholar Google Scholar Articles by Akosah, K. O. Articles by Devine, S. Search for Related Content PubMed PubMed Citation Articles by Akosah, K. O. Articles by Devine, S.

Improving Care for Patients With Chronic Heart Failure in the Community^*

The Importance of a Disease Management Program

^* From the Gundersen Lutheran Medical Foundation, La Crosse, WI.

Correspondence to: Kwame O. Akosah, MD, Gundersen Lutheran Medical Foundation, 1836 South Ave, La Crosse, WI 54601; e-mail: kakosah{at}gundluth.org

Study objective: Utilizing a comparison group of patients with congestive heart failure (CHF) discharged to their primary care physicians, we sought to determine if disease management in a short-term, aggressive-intervention heart failure clinic (HFC) following hospital discharge is associated with improved outcomes.

Design: Chart review.

Setting: An integrated health-care center serving a tristate area.

Patients: Inclusion criteria were discharge from the hospital with a primary diagnosis of CHF, outpatient follow-up within the hospital system, and the presence of left ventricular systolic dysfunction as the basis for CHF. Patients were categorized into group 1 if they were referred to the HFC after hospital discharge, and into group 2 if follow-up care was provided by their primary care physician.

Measurements and results: There were 38 patients in group 1 and 63 patients in group 2. There was a trend toward a shorter time to the first outpatient visit following discharge (11 days vs 15 days, p = 0.09), more outpatient visits within 90 days (10 visits vs 2 visits, p < 0.001), and more patient-initiated contacts (four contacts vs one contact, p = < 0.001) in group 1 compared to group 2, respectively. The combined hospital readmission and mortality rate at 90 days (10% vs 30%, p < 0.018) and 1 year (21% vs 43%, p < 0.02) was lower in group 1. There was a 77% relative risk reduction for 30-day hospital readmission in favor of group 1, and a statistically lower rate of readmissions at 90 days and 1 year. Utilization and maintenance of standardized CHF medications were significantly higher in patients who attended the HFC.

Conclusions: A comprehensive disease management program for patients discharged with a diagnosis of CHF resulted in fewer rehospitalizations and improved event-free survival compared to patients followed up by their primary care physicians.

Key Words: congestive heart failure • disease management • outcomes

This article has been cited by other articles:

				C. D. Miller, D. C. Ziemer, P. Kolm, I. M. El-Kebbi, C. B. Cook, D. L. Gallina, J. P. Doyle, C. S. Barnes, and L. S. Phillips Use of a Glucose Algorithm to Direct Diabetes Therapy Improves A1C Outcomes and Defines an Approach to Assess Provider Behavior. The Diabetes Educator, July 1, 2006; 32(4): 533 - 545. [Abstract] [Full Text] [PDF]

				M. Komajda, P. Lapuerta, N. Hermans, J. R. Gonzalez-Juanatey, D. J. van Veldhuisen, E. Erdmann, L. Tavazzi, P. Poole-Wilson, and C. Le Pen Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey Eur. Heart J., August 2, 2005; 26(16): 1653 - 1659. [Abstract] [Full Text] [PDF]

				B. J. Daly, S. L. Douglas, C. G. Kelley, E. O'Toole, and H. Montenegro Trial of a Disease Management Program to Reduce Hospital Readmissions of the Chronically Critically Ill Chest, August 1, 2005; 128(2): 507 - 517. [Abstract] [Full Text] [PDF]

				K. O. Akosah, A. M. Schaper, L. M. Haus, M. A. Mathiason, S. I. Barnhart, and V. L. McHugh Improving Outcomes in Heart Failure in the Community: Long-term Survival Benefit of a Disease-Management Program Chest, June 1, 2005; 127(6): 2042 - 2048. [Abstract] [Full Text] [PDF]

				F. Gustafsson and J. M. O. Arnold Heart failure clinics and outpatient management: review of the evidence and call for quality assurance Eur. Heart J., September 2, 2004; 25(18): 1596 - 1604. [Abstract] [Full Text] [PDF]

				D. P. Faxon, L. H. Schwamm, R. C. Pasternak, E. D. Peterson, B. J. McNeil, V. Bufalino, C. W. Yancy, L. M. Brass, D. W. Baker, R. O. Bonow, et al. Improving Quality of Care Through Disease Management: Principles and Recommendations From the American Heart Association's Expert Panel on Disease Management Circulation, June 1, 2004; 109(21): 2651 - 2654. [Full Text] [PDF]

				R. Rozzini, T. Sabatini, M. Trabucchi, and K. O. Akosah Chronic Heart Failure Management: A Realistic Program Chest, May 1, 2003; 123(5): 1770 - 1771. [Full Text] [PDF]