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(Chest. 2005;127:2042-2048.)
© 2005 American College of Chest Physicians

Improving Outcomes in Heart Failure in the Community*

Long-term Survival Benefit of a Disease-Management Program

Kwame O. Akosah, MD; Ana M. Schaper, PhD; Lindsay M. Haus, BA; Michelle A. Mathiason, MS; Sharon I. Barnhart, BSN and Vicki L. McHugh, MS

* From the Gundersen Lutheran Health System, La Crosse, WI.

Correspondence to: Kwame O. Akosah, MD, Gundersen Lutheran Health System, 1900 South Ave, La Crosse, WI 54601; e-mail: koakosah{at}gundluth.org

Objectives: The purpose of our current study was to determine whether our disease-management model was associated with long-term survival benefits. A secondary objective was to determine whether program involvement was associated with medication maintenance and reduced hospitalization over time compared to usual care management of heart failure.

Design: A retrospective chart review was conducted in patients who had been hospitalized for congestive heart failure between April 1999 and March 31, 2000, and had been discharged from the hospital for follow-up in the Heart Failure Clinic vs usual care.

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

Patients: Patients (n = 101) were followed up for 4 years after their index hospitalization for congestive heart failure.

Measurements and results: The patients followed up in the Heart Failure Clinic comprised group 1 (n = 38), and the patients receiving usual care made up group 2 (n = 63). The mean (± SD) age of the patients in group 1 was 68 ± 16 years compared to 76 ± 11 years for the patients in group 2 (p = 0.002). The patients in group 1 were more likely to have renal failure (p = 0.035), a lower left ventricular ejection fraction (p = 0.005), and hypotension at baseline (p = 0.002). At year 2, more patients in group 1 were maintained by therapy with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) [p = 0.036]. The survival rate over 4 years was better for group 1. Univariate Cox proportional hazard ratios revealed that age, not receiving ACEIs or ARBs, and renal disease or cancer at baseline were associated with mortality. When controlling for these variables in a multivariate Cox proportional hazards ratio model, survival differences between groups remained significant (p = 0.021). Subjects in group 2 were 2.4 times more likely to die over the 4-year period than those in group 1.

Conclusions: Our study demonstrated that, after controlling for baseline variables, patients participating in a heart failure clinic enjoyed improved survival.

Key Words: cardiology • congestive heart failure • disease management • outcomes






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