TY - JOUR
T1 - Effect of moderate or intensive disease management program on outcome in patients with heart failure
T2 - 56th Annual Scientific Session of the American-College-of-Cardiology
AU - Jaarsma, T.
AU - van der Wal, Martje H.L.
AU - Lesman-Leegte, Ivonne
AU - Luttik, Marie-Louise
AU - Hogenhuis, Jochem
AU - Veeger, Nic J.
AU - Sanderman, Robbert
AU - Hoes, A.W.
AU - van Gilst, Wiek H.
AU - Lok, D.J.
AU - Dunselman, P.H.
AU - Tijssen, J.G.
AU - Hillege, Hans L.
AU - van Veldhuisen, Dirk J.
PY - 2008/2/11
Y1 - 2008/2/11
N2 - Background:: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.Methods: The Coordinating Stud), Evaluating Out-comes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.Results: Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P=.73 and P=.52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P =.81), and 34 268 for the intensive support group (P =.49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08 P=.18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P =.89; and intensive support group, P =.60).Conclusions: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups.Clinical Trial Registry: http://trialregister.nl Identifier: NCT 98675639.
AB - Background:: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.Methods: The Coordinating Stud), Evaluating Out-comes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.Results: Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P=.73 and P=.52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P =.81), and 34 268 for the intensive support group (P =.49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08 P=.18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P =.89; and intensive support group, P =.60).Conclusions: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups.Clinical Trial Registry: http://trialregister.nl Identifier: NCT 98675639.
KW - RANDOMIZED-TRIAL
KW - ELDERLY-PATIENTS
KW - HIGH-RISK
KW - CARE
KW - INTERVENTION
KW - MULTIDISCIPLINARY
KW - ADMISSION
KW - READMISSIONS
KW - GUIDELINES
KW - SURVIVAL
M3 - Article
VL - 168
SP - 316
EP - 324
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
IS - 3
Y2 - 24 March 2007 through 27 March 2007
ER -