[Heart failure: the importance of a disease management program]

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Context:

• Heart failure (HF) is a growing public health concern with high hospitalization rates, significantly impacting patient quality of life and healthcare costs.
• Existing disease management programs and multidisciplinary approaches aim to reduce HF hospitalizations, as highlighted in recent consensus documents.
• Previous studies on intervention programs show mixed results regarding admission reduction and survival benefits, necessitating further investigation.

Purpose:

• To evaluate the effectiveness of a centralized telephone intervention program for heart failure (HF) patients in reducing hospitalizations and improving outcomes.
• To analyze hospitalization predictors and readmission rates in a large cohort of Italian HF patients using the IN-CHF registry.
• To assess the impact of multidisciplinary care continuity on HF admissions and mortality.

Summary:

• The multicenter randomized DIAL study found that a centralized telephone intervention significantly reduced heart failure admissions but not all-cause admissions or mortality compared to usual care.
• Data from the IN-CHF registry (9000 patients) identified prior HF hospitalization as the strongest predictor of rehospitalization, with 44% hospitalized within the year before enrollment.
• Patients in advanced functional classes (NYHA class III-IV) and with ischemic etiology faced higher rehospitalization rates.

Impact:

• Findings suggest that targeted telephone interventions can effectively decrease HF-specific hospitalizations, offering a potential strategy for managing this chronic condition.
• Identifying high-risk patient groups (e.g., those with prior admissions, advanced NYHA class, ischemic heart disease) allows for focused resource allocation and preventative care.
• The study underscores the significant burden of HF hospitalizations in Italy and the need for effective management strategies to improve patient outcomes and reduce healthcare expenditure.