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Lack of long-term benefits of a 6-month heart failure disease management program
Viviane Nguyen1, Anique Ducharme, Michel White
1Montreal Heart Institute Research Center, Montreal, Quebec, Canada.
Insights
A 6-month heart failure management program (HFMP) showed initial benefits, but these effects on hospital readmissions and emergency visits did not last long-term. Further research on sustained HFMP is needed.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Heart failure (HF) is a significant healthcare burden, leading to frequent hospitalizations and emergency department (ED) visits.
- Previous studies demonstrated short-term benefits of a multidisciplinary HF clinic, including reduced readmissions and improved quality of life.
- The long-term sustainability of these benefits after program completion remained unclear.
Purpose of the Study:
- To evaluate the long-term impact of a 6-month intensive heart failure management program (HFMP) on recurrent ED visits, hospital readmissions, and mortality.
- To determine if the initial positive outcomes of the HFMP are maintained after the program's cessation.
Main Methods:
- A retrospective analysis of 190 patients (New York Heart Association Class II-IV) initially randomized to a 6-month HFMP or standard care.
- Long-term follow-up data (mean 2.8 years) was collected from Quebec administrative health databases.
- Comparison of composite endpoints (all-cause death, hospital admissions, ED visits) and all-cause death between the HFMP and control groups.
Main Results:
- No significant difference was observed in the composite endpoint of all-cause death, hospital admissions, and ED visits between the HFMP and control groups after a mean follow-up of 2.8 years.
- Multivariable analysis confirmed no significant difference in the primary composite endpoint (HR 1.01) or all-cause death (HR 1.09) between groups.
- The initial clinical and resource benefits of the 6-month HFMP were not sustained long-term.
Conclusions:
- The benefits of a 6-month heart failure management program (HFMP) are not sustained once the program ends for severely ill patients.
- Further investigation is necessary to explore the long-term efficacy and potential modifications of HFMP.
- Long-term strategies are needed to maintain positive outcomes for heart failure patients post-program.
Background:
Heart failure (HF) represents a major burden on the health care system, causing repeated hospitalizations and numerous emergency department (ED) visits. In a 6-month randomized study of a multidisciplinary HF clinic, we have previously shown decreased hospital readmissions and improved quality of life. Despite these encouraging results, it is unknown if these beneficial effects are sustained.
Methods And Results:
To assess long-term recurrent ED visits, readmissions, and mortality among HF patients who were discharged after a 6-month intensive HF management program (HFMP). Of the 230 subjects (New York Heart Association Class II-IV) who were initially randomized to standard follow-up care or to a HFMP for 6 months, 190 were studied retrospectively for long-term evaluation. Long-term data was obtained from the Quebec administrative health databases. We compared the intervention and control groups for the number of recurrent ED visits, hospital readmissions, and all-cause deaths. After a mean follow-up of 2.8 +/- 1.7 years, there was no difference in the composite end point of all-cause death, hospital admissions, and ED visits between those patients initially in the HFMP group and the controls. After multivariable adjustment, there was no difference in the composite primary endpoint (HR 1.01, 95% CI: 0.75-1.37) or in the secondary end point of all-cause death alone (HR 1.09, 95%CI:0.69-1.72) between those initially assigned to the HF clinic and those receiving usual care.
Conclusions:
For severely ill patients, the clinical and resource benefits of a 6-month HFMP are not sustained upon program cessation. Further research into the benefits of long-term HFMP is required.
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