A Comprehensive Management System for Heart Failure Improves Clinical Outcomes and Reduces Medical Resource Utilization

West, Jeffrey A.; Miller, Nancy Houston; Parker, Karen J.; Senneca, Deborah; Ghandour, Ghassan; Clark, Mia; Greenwald, George; Heller, Robert S.; Fowler, Michael B.; DeBusk, Robert F.

doi:10.1016/s0002-9149(96)00676-5

Cited by 298 publications

(167 citation statements)

References 22 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“…31,32 These programs' effects on noncardiac outcomes also need to be analyzed, particularly as so many older patients have multiple comorbid conditions. 1 The best solution for one health care system may not be generalizable to other organizations.…”

Section: Discussionmentioning

confidence: 99%

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

et al. 1997

View full text Add to dashboard Cite

OBJECTIVE:To quantify the extent and determinants of underutilization of angiotensin-converting enzyme (ACE) inhibitors for patients with congestive heart failure, especially with respect to physician specialty and clinical indication. DESIGN:Survey of a national systematic sample of physicians. PARTICIPANTS:Five hundred family practitioners, 500 general internists, and 500 cardiologists. MEASUREMENTS AND MAIN RESULTS:Physicians' choice of medications were determined for four hypothetical patients with left ventricular systolic dysfunction: (1) new-onset, symptomatic; (2) asymptomatic; (3) chronic heart failure, on digitalis and diuretic; and (4) asymptomatic, post-myocardial infarction. For each patient, randomized controlled trials have demonstrated that ACE inhibitors decrease mortality or the progression of symptoms. Among the 727 eligible physicians returning surveys (adjusted response rate 58%), approximately 90% used ACE inhibitors for patients with chronic heart failure who were already taking digitalis and a diuretic. However, family practitioners and general internists chose ACE inhibitors less frequently ( p Յ .01) than cardiologists for the other indications. Respective rates of ACE inhibitor use for each simulated patient were new-onset, symptomatic (family practitioners 72%, general internists 76%, cardiologists 86%); asymptomatic (family practitioners 68%, general internists 78%, cardiologists 93%); and asymptomatic, postmyocardial infarction (family practitioners 58%, general internists 70%, cardiologists 94%). Compared with generalists, cardiologists were more likely ( p Յ .05) to increase ACE inhibitors to a target dosage (45% vs 26%) and to tolerate systolic blood pressures of 90 mm Hg or less (43% vs 15%). he appropriate role of generalist and specialist physicians in the care of patients is controversial. 1 It is generally assumed that the sickest, most complicated patients, as well as patients with rare disorders, benefit most from specialty care. However, the majority of patients with chronic diseases such as heart failure, diabetes, or chronic obstructive pulmonary disease initially are not severely ill, and are therefore first seen by the generalist physician. The most cost-effective threshold for specialty referral and the optimal mix of generalist and specialist care remain unknown. 2 Congestive heart failure is an ideal model to study variation in physicians' practice patterns among patients with chronic disease. This syndrome is common and presently the domain of both generalist and specialist physicians. Advances in cardiac transplantation and hemodynamically titrated therapy have made some of the sickest patients clear candidates for referral to cardiologists. 3 Recently, however, multicenter trials of angiotensin-converting enzyme (ACE) inhibitors have modified the standard of treatment for a broad range of patients with heart failure. 4 These medications have been found to decrease mortality in patients with chronic heart failure and ejection fractions of 0.35 or less, 5 decrease...

show abstract

Section: Discussionmentioning

confidence: 99%

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

et al. 1997

View full text Add to dashboard Cite

show abstract

“…Isso tem motivado a procura de novas abordagens no manuseio da ICC, visando a reduzir custos. Recentemente, foram criadas as chamadas "clínicas de ICC" formadas por equipe multidisciplinar, composta por médi-cos, enfermeiros, nutricionistas e fisioterapeutas, tendo-se observado que esse tipo de abordagem reduz a taxa de reinternação, melhora a qualidade de vida e prolonga a sobrevida, ao mesmo tempo em que reduz custos 5,25,26 . Em um estudo, observou-se redução de 44,4% na taxa de reinternações e de 35,7% no tempo de hospitalização com mortalidade significativamente menor 5 .…”

Section: Discussionunclassified

Evolução intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência

Villacorta¹,

Rocha²,

Cardoso³

et al. 1998

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Purpose -To evaluate the in-hospital (IH) outcome and the short-term follow-up of predominantly elderly patients presenting to an emergency room (ER) with congestive heart failure (CHF). Methods -In an 11 month period, 57 patients presenting to the ER with CHF were included. Mean age was 69+15 years (27 to 94) and 39 (68,4%) A síndrome de insuficiência cardíaca congestiva (ICC) apresenta prevalência de 1 a 2% na população geral 1-3 . Em indivíduos com idades entre 65 e 67 anos, esse número eleva-se para 23% 4 , tornando-se problema sério em idosos. Nos Estados Unidos é a principal causa de internação em

show abstract

“…Bearing in mind the great significance of hospital costs, it is essential to find ways of treating heart failure that reduce the need for this type of care. In this context, it is interesting to note that international studies have shown that treatment programmes covering such disparate areas as medication, diet, exercise and education of patients and their relatives with respect to home care can reduce the need for hospital care and shorten the number of days per hospitalization, whilst also improving the patient's functional status and quality of life [3,4,26,27]. There is also increasing interest in Sweden in the development of this kind of structured care programme [28].…”

Section: R Y D E â N -B E R G S T E N and F A N D E R S S O Nmentioning

confidence: 99%

The health care costs of heart failure in Sweden

Rydén‐Bergsten

Andersson

1999

Journal of Internal Medicine

139

View full text Add to dashboard Cite

Abstract. Ryde Ân-Bergsten T, Andersson F (AstraZeneca R&D, Lund; and AstraZeneca R&D, Mo Èlndal; Sweden). The health care costs of heart failure in Sweden. J Intern Med 1999; 246: 275±284.Aim. Heart failure is a common and serious condition requiring extensive health care resources. The aim of this study is to estimate the total treatment costs of heart failure in Sweden.Methods and results. The study is a prevalencebased cost-of-illness study. It includes costs of institutional care (hospitals and nursing homes), outpatient care, surgery and drugs. The costs are estimated based on official Swedish statistics, and on various clinical and epidemiological studies. The results are expressed in 1996 prices. The total annual treatment costs for heart failure are approximately Swedish kronor (SEK) 2000±2600 million, or nearly 2% of the Swedish health care budget. Institutional care is the single largest component, amounting to SEK 1300±1900 million, or about 65±75% of the costs of heart failure treatment. Conclusions. The results from this study indicate that heart failure is a costly condition. Efforts to develop effective management programmes that can reduce the need for expensive institutional care, without a negative impact on quality of life, morbidity and mortality, should be given high priority.

show abstract

A Comprehensive Management System for Heart Failure Improves Clinical Outcomes and Reduces Medical Resource Utilization

Cited by 298 publications

References 22 publications

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

Evolução intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência

The health care costs of heart failure in Sweden

Contact Info

Product

Resources

About