© 2004 European Society of Cardiology
Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program
a Department of Cardiology, Hospital General Universitario de Valencia Valencia, Spain
b Department of Cardiology, Hospital La Fe Valencia, Spain
c Department of Cardiology, Hospital Reina Sofía Córdoba, Spain
d Department of Statistics, Universidad Politécnica de Valencia Spain
* Corresponding author. Present address: Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, C/Dr Esquerdo, 46, 28007 Madrid, Spain. Tel.: +34-915868281; Fax: +34-915868291. E-mail address: fatienzaf{at}meditex.es
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Abstract |
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Aims: Disease management programs can reduce hospitalizations in high-risk heart failure (HF) patients, but generalizability to the population hospitalized for HF remains to be proven. We aimed to assess the effectiveness of a discharge and outpatient management program in a non-selected cohort of patients hospitalized for HF.
Methods and results: Patients admitted with decompensated HF were randomized to receive usual care (n=174) or an intervention (n=164) consisting of a comprehensive hospital discharge planning and close follow-up at a HF clinic. After a median of 509 days, there were fewer events (readmission or death) in the intervention as compared with the control group (156 vs. 250), which represents 47% (95%CI: 29–65; P<0.001) event reduction per observation year. At 1-year, time to first event, time to first all-cause and HF readmission, and time to death were increased in the intervention group (P<0.001). All-cause and HF readmission rates per observation year were significantly lower, quality of life improved and overall cost of care was reduced in the intervention group.
Conclusions: This comprehensive hospital discharge and outpatient management program prolonged time to first event, reduced hospital readmissions, improved survival and quality of life of patients hospitalized for HF, while reducing cost of management.
Key Words: Heart failure • Disease management programs • Heart failure clinic • Readmissions • Mortality
Received August 15, 2003; Accepted November 7, 2003
These authors belongs to the PRICE study group.
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