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A brief cognitive-behavioral intervention reduces hospital admissions in refractory angina patients
Roger K G Moore1, David G Groves, John D Bridson
1Cardiothoracic Center, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.
Insights
A cognitive-behavioral chronic disease management program (CB-CDMP) significantly reduced hospital admissions and myocardial infarctions in chronic refractory angina patients. This approach offers potential healthcare savings and improved quality of life.
Area of Science:
- Cardiology
- Behavioral Medicine
- Health Economics
Background:
- Chronic refractory angina is a prevalent, complex pain condition leading to frequent hospitalizations.
- Previous research indicated a novel outpatient cognitive-behavioral chronic disease management program (CB-CDMP) improves angina status and quality of life.
Purpose of the Study:
- To evaluate the impact of a CB-CDMP on hospital admissions, myocardial infarctions, and mortality in chronic refractory angina patients.
- To assess the cost-effectiveness and healthcare savings associated with the CB-CDMP.
Main Methods:
- A study involving 271 chronic refractory angina patients enrolled in an outpatient CB-CDMP.
- Analysis of total hospital admissions, bed day occupancy, myocardial infarctions, and overall mortality before and after program enrollment.
Main Results:
- Total hospital admissions decreased from 2.40 to 1.78 per patient per year (P<0.001).
- Hospital bed day occupancy reduced from 15.48 to 10.34 days per patient per year (P<0.001).
- Myocardial infarctions dropped from 32 to 8 (14% vs. 2.3%, P<0.001), with lower overall mortality compared to surgical groups.
Conclusions:
- Educating patients via a brief outpatient CB-CDMP leads to immediate and sustained reductions in hospital admission costs, offering significant healthcare savings.
- The CB-CDMP improves symptoms and quality of life, presenting a low-cost alternative to palliative revascularization for symptom management.
Abstract:
Chronic refractory angina is an increasingly prevalent, complex chronic pain condition, which results in frequent hospitalization for chest pain. We have previously shown that a novel outpatient cognitive-behavioral chronic disease management program (CB-CDMP) improves angina status and quality of life in such patients. In the present study of 271 chronic refractory angina patients enrolled in our CB-CDMP, total hospital admissions were reduced from 2.40 admissions per patient per year to 1.78 admissions per patient per year (P<0.001). The rising trend of total hospital bed day occupancy prior to enrollment fell from 15.48 days per patient per year to a stable 10.34 days per patient per year (P<0.001). There were 32 recorded myocardial infarctions prior to enrollment compared to eight in the year following enrollment (14% vs. 2.3%, P<0.001) and overall mortality was lower that comparable groups treated with surgery. This study shows that educating patients and demystifying angina using a brief outpatient CB-CDMP produces an immediate and sustained reduction in hospital admission costs that represents a major potential health care saving. This benefit accrues in addition to the known effects of CB-CDMP on symptoms and quality of life. These data suggest that a CB-CDMP approach to symptom palliation represents a low cost alternative to palliative revascularization.
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