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Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial

Carol E Smith1, Ubolrat Piamjariyakul1, Jo A Wick1

  • 1From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.).

Circulation. Heart Failure
|September 20, 2014
PubMed

Insights

Multidisciplinary group clinic appointments improved heart failure (HF) self-management and reduced rehospitalizations initially. Benefits on HF survival were observed during the intervention period, suggesting potential for improved patient outcomes.

Area of Science:

  • Cardiology
  • Health Services Research

Background:

  • Heart failure (HF) poses a significant burden on healthcare systems, necessitating innovative management strategies.
  • Multidisciplinary care models are increasingly explored to improve patient outcomes and reduce hospitalizations.

Purpose of the Study:

  • To evaluate the impact of multidisciplinary group clinic appointments on heart failure (HF) rehospitalization or death.
  • To assess the effect of the intervention on patient adherence to HF medications and hospitalization-free survival.

Main Methods:

  • A randomized trial involving 198 HF patients comparing standard care with standard care plus multidisciplinary group clinics.
  • The intervention included 4 weekly group sessions and a 6-month booster session focused on HF self-management skills.
  • Data on HF rehospitalization, death, and medication adherence were prospectively collected over 12 months.

Main Results:

  • The intervention group showed greater adherence to recommended vasodilators (P=0.04).
  • Hospitalization-free survival was significantly longer in the intervention group from 2 to 7 months post-randomization (HR=0.45, P=0.04).
  • Total HF-related hospitalizations were lower in the intervention group (28 vs. 45).

Conclusions:

  • Multidisciplinary group clinic appointments are associated with improved adherence to HF medications.
  • The intervention demonstrated a significant benefit in extending hospitalization-free survival during the active treatment phase.
  • Further research is warranted to confirm these findings and explore methods for sustaining the observed benefits in heart failure management.
Abstract

Keywords:
clinical trialheart failuresurvival analysis

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