Clinical Question: Does a disease m...

Clinical Question: Does a disease management program improve consequences in patients with heart failure?

Setting: Outpatient (any)

close attention Design: Randomized controlled trial (nonblinded)

Allocation: Uncertain

Synopsis: In this reflection investigators enlisted persons in the community to identify those with possible symptoms of heart failure. [i]role[/i]s with a positive screening originate had echocardiography, and those with systolic heart failure (defined as an ejection fraction of les than 49 percent) or diastolic heart failure (defined as left ventricular hypertrophy E-A reversal, or abnormal transmitral flow) were invited to enlist in the study. Enrollees were randomized in a 2:1 ratio to disease management or usual care.

Disease management was provided by means of a private firm and consisted of handing not at home scales, providing a detailed treatment plan, emphasizing that patients received all indicated medications, and placing weekly and then monthly phone calls. single in kind half of the patients also received in-home pulsation oximetry and blood pressure monitoring.

Patients underwent a detailed evaluation each six months, and were followed up for 18 month clumps were balanced at the start of the research and analysis was by intention to treat, moreover neither the patients nor the investigators were blinded. The average age of participants was 71 years, 29 percent were women 71 percent were white, 62 percent had coronary artery disease, 72 percent had hypertension, and 28 percent had diabetes. in the greatest degree patients had systolic heart failure (70 percent) with an average ejection fraction of 35 percent in this group

After 18 month all-cause mortality was significantly reduc in patients with systolic heart failure however not in those with diastolic heart failure. Patients with systolic heart failure who were registered in the disease management program had a longer mean survival (526 versus 445 days; P = 012) than those receiving usual care. The benefit was greatest for patients with more methodical disease (hazard ratio = 132 for fresh York Heart Association [NYHA] class I, 076 for NYHA class II, and 054 for NYHA class III or IV; and nothing else the last hazard ratio was statistically significant). There were no differences between the assemblages regarding cost, hospitalization, or any other measures of health care use.

Bottom Line: A disease management program moulds mortality in patients with moderate to strict systolic heart failure. Patients with milder symptoms and those with diastolic heart failure did not benefit. The program did not model overall health care use or richnesss (Level of Evidence: 1b-)

close attention Reference: Galbreath AD, et al. Long-term healthcare and take away from outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation December 7 2004;110:3518-26

Used with permission from Ebell M Disease mgmt for mod-severe systolic HF abates mortality but not cost. Accessed online March 31 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group