Heart failure care in a hospital unit: a comparison of standard 3-month and extended 6-month programs

Abstract

Background: We have previously shown that a structured in-hospital and outpatient heart failure (HF) program reduces clinical events over a 3-month period following hospital discharge. Aims: This prospective randomized controlled study examines the additional benefits of extending the standard 3-month HF program to 6 months on death and readmission over a 2-year follow-up period. Methods: Of 161 patients admitted with NYHA class IV HF who completed the standard 3-month HF program, 130 consenting patients (mean age 69.9F12.2 years, 65% male) were randomized to the extended 6-month HF program (EP; n=62) or standard care (SP; n=68). The primary endpoint was death and/or unplanned rehospitalization for HF at 2 years postrandomization. Results: In the 2-year follow-up period, there were eight people with unplanned hospitalizations for HF and 16 deaths in the EP group (event rate 38.7%) compared to seven people with unplanned HF readmissions and 14 deaths in the SP group (event rate 30.9%, p=0.348 versus EP). Kaplan-Meier survival analysis demonstrated no difference in outcome between standard and extended program ( p=0.315). There were no differences between the groups in terms of unscheduled clinic visits or non-HF-related readmissions in the 2-year follow-up period. Conclusions: There is no measured clinical advantage in terms of death and/or HF readmission in extending a structured hospital-based disease management program for HF beyond 3 months postdischarge. However, it appears that patients continue to need access to the service to help abort clinical deteriorations, and this may have implication for the optimal organisation of such programs.

Long-Term Prospective, Randomized, Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients

“…1,[18][19][20] Also, our results do not support the concept that long-term, intensive postdischarge follow-up is unnecessary, especially in patients with nonadvanced HF who are under ambulatory care, providing that the patient has immediate access to specialist service in the event of suspected deterioration. 21,22 However, our results are in accordance with the long-term benefit of DMP reported recently regarding heart failure clinics and home-based intervention for HF patients after hospital discharge. [23][24][25][26] REMADHE is a unique study with sequential quality-oflife results on long-term follow-up in nonadvanced HF outpatients.…”

Serial NT-proBNP monitoring and outcomes in outpatients with decompensation of heart failure

“…Due to the shortness of hospital beds for HF patients and the need of these patients for close monitoring and assistance, structured HF care plans have evolved to address these problems. Recent reports show that a structured HF program reduces clinical events over a 3-month period [21] without clinical advantage (in terms of death and/or HF readmission) extending the program beyond 3 months [22]. In this study we report the prognostic value of plasma NT-proBNP in a structured in-hospital and outpatient HF program.…”

Profiling B-type natriuretic peptide in a stable heart failure population: a valuable adjunct to care

“…Details of the DMP which has been operational since 1998 have been described previously [17,18]. We included patients followed in the clinic following an emergency class IV HF admission, outpatients diagnosed with HF in a new diagnostic HF clinic, or patients with an established diagnosis of HF referred for management to the clinic.…”