Randomized, controlled trial of integrated heart failure management. The Auckland Heart Failure Management Study

Abstract

Aims To determine the effect of an integrated heart failure management programme, involving patient and family, primary and secondary care, on quality of life and death or hospital readmissions in patients with chronic heart failure. Methods and ResultsThis trial was a cluster randomized, controlled trial of integrated primary/secondary care compared with usual care for patients with heart failure. The intervention involved clinical review at a hospital-based heart failure clinic early after discharge, individual and group education sessions, a personal diary to record medication and body weight, information booklets and regular clinical follow-up alternating between the general practitioner and heart failure clinic. Follow-up was for 12 months. One hundred and ninety-seven patients admitted to Auckland Hospital with an episode of heart failure were enrolled in the study. There was no significant difference between the intervention and control groups for the combined end-point of death or hospital readmission. The physical dimension of quality of life showed a greater improvement in the intervention group from baseline to 12 months compared with the control group ( 11·1 vs 5·8 respectively, 2P=0·015). The main effect of the intervention was attributable to the prevention of multiple admissions (56 intervention group vs 95 control group, 2P=0·015) and associated reduction in bed days.Conclusions This integrated management programme for patients with chronic heart failure improved quality of life and reduced total hospital admissions and total bed days.

Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

“…The majority of studies related to patients with diabetes (n = 6; Simmons 2003; Nocon et al 2004;Smith et al 2004;Kirsh et al 2007;Borgermans et al 2009;Askew et al 2010;Goderis et al 2010;Jackson et al 2010). Three were from New Zealand (Doughty et al 2002;Pearl et al 2003;Rea et al 2004;Sheridan et al 2009), two each from Australia (Simmons 2003;Askew Jackson et al 2010;Jackson Tsai et al 2010) and the UK (Nocon et al 2004;Coast et al 2005;Salisbury et al 2005), with the remaining three from the US (Kirsh et al 2007), Belgium (Borgermans et al 2009;Goderis et al 2010) and Ireland (Smith et al 2004). One study was an RCT Salisbury et al 2005), four were cluster RCTs (Doughty et al 2002;Pearl et al 2003;Rea et al 2004;Smith et al 2004;Borgermans et al 2009;Goderis et al 2010), three reported a quasi-experimental design (Nocon et al 2004;Kirsh et al 2007;Askew et al 2010;Jackson et al 2010) and two used a pre-post design (Simmons 2003;Sheridan et al 2009).…”

“…Three were from New Zealand (Doughty et al 2002;Pearl et al 2003;Rea et al 2004;Sheridan et al 2009), two each from Australia (Simmons 2003;Askew Jackson et al 2010;Jackson Tsai et al 2010) and the UK (Nocon et al 2004;Coast et al 2005;Salisbury et al 2005), with the remaining three from the US (Kirsh et al 2007), Belgium (Borgermans et al 2009;Goderis et al 2010) and Ireland (Smith et al 2004). One study was an RCT Salisbury et al 2005), four were cluster RCTs (Doughty et al 2002;Pearl et al 2003;Rea et al 2004;Smith et al 2004;Borgermans et al 2009;Goderis et al 2010), three reported a quasi-experimental design (Nocon et al 2004;Kirsh et al 2007;Askew et al 2010;Jackson et al 2010) and two used a pre-post design (Simmons 2003;Sheridan et al 2009). Eight studies used quantitative methods (Doughty et al 2002;Pearl et al 2003;Simmons 2003;Rea et al 2004;Smith et al 2004;Coast et al 2005;Salisbury et al 2005;Kirsh et al 2007;Borgermans et al 2009;Askew et al 2010;Goderis et al 2010;Jackson et al 2010), whereas two used a mixed-methods approach …”

“…One study was an RCT Salisbury et al 2005), four were cluster RCTs (Doughty et al 2002;Pearl et al 2003;Rea et al 2004;Smith et al 2004;Borgermans et al 2009;Goderis et al 2010), three reported a quasi-experimental design (Nocon et al 2004;Kirsh et al 2007;Askew et al 2010;Jackson et al 2010) and two used a pre-post design (Simmons 2003;Sheridan et al 2009). Eight studies used quantitative methods (Doughty et al 2002;Pearl et al 2003;Simmons 2003;Rea et al 2004;Smith et al 2004;Coast et al 2005;Salisbury et al 2005;Kirsh et al 2007;Borgermans et al 2009;Askew et al 2010;Goderis et al 2010;Jackson et al 2010), whereas two used a mixed-methods approach (Nocon et al 2004;Sheridan et al 2009). …”

Failure of an Educational Program: Experiences of the Vienna Heart School

“…Previous studies to improve adherence in several countries were successful regarding quality of therapy and reduction of readmissions. In these studies, heart failure patients underwent lessons during hospitalization 1-4 after discharge from the hospital, 5,6 were treated by an out-patient clinic specializing in heart failure, 7 -9 or by multidisciplinary interventions. 10,11 Hypothesizing that improving the knowledge of the disease would lead to better adherence, 12 reduce readmission, mortality, and thus probably reduce health costs, 13,14 we established the Vienna Heart School (VHS).…”

Chronic case management: Clinical governance with cost reductions

“…In this context, according to Lynce 2007, 8 5% of chronically ill patients consumed 30% of inpatient costs in Portugal. With quality management it is possible to obtain values as significant as a 40% reduction in hospital admissions due to chronic respiratory diseases, 25% reduction in hospitalizations due to diabetes; 38% reduction in emergency calls to patients with asthma, [9][10][11][12] and 50% reduction in the occurrence of absenteeism due to arthritis. 13 Thus, our study aimed to evaluate the epidemiological profiles and total health care costs of a group of patients with CDNCD at a Brazilian supplementary health service that was monitored by a CDMCP.…”