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Factors Associated With Inadequate Effectiveness of a Multidisciplinary Disease Management Program in Heart Failure

Min-Hui Liu1,2,3, Chao-Hung Wang1,2, Ai-Fu Chiou3

  • 11 Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.

Biological Research for Nursing
|July 23, 2016
PubMed

Insights

Multidisciplinary disease management programs (MDPs) are less effective for heart failure (HF) patients with high galectin-3 (Gal-3) levels. Identifying non-responders can improve HF care quality and patient outcomes.

Area of Science:

  • Cardiology
  • Biomarkers in Heart Failure
  • Disease Management Programs

Background:

  • Heart failure (HF) management programs aim to reduce mortality and rehospitalization.
  • Galectin-3 (Gal-3) is a biomarker associated with HF severity and prognosis.
  • Stratifying HF patients by Gal-3 levels may reveal differential responses to management interventions.

Purpose of the Study:

  • To determine if multidisciplinary disease management programs (MDPs) have consistent effects across different galectin-3 (Gal-3) levels in heart failure (HF) patients.
  • To identify factors associated with inadequate MDP effectiveness in HF patients.
  • To assess the prognostic value of Gal-3 levels in HF.

Main Methods:

  • A longitudinal follow-up of 355 stabilized hospitalized HF patients from a previous randomized trial.
  • Analysis of MDP effects on death and HF-related rehospitalization, stratified by Gal-3 levels.
  • Multivariable analysis to identify factors associated with composite events in high-Gal-3 patients.

Main Results:

  • Gal-3 levels significantly predicted mortality and composite events (p < .001).
  • MDP demonstrated a significant event-lowering effect (HR = 0.49 for death, HR = 0.50 for composite events).
  • MDP effectiveness was inadequate for high-Gal-3 patients (≥17.9 ng/ml), with a 4-year composite event rate of 43% in the MDP arm.

Conclusions:

  • MDP effectiveness is inadequate for high-risk HF patients identified by elevated Gal-3 levels.
  • Key characteristics of MDP non-responders include older age, worse NYHA class, specific medication non-use, higher natriuretic peptide levels, and wider QRS complexes.
  • Integrating advanced care plans guided by Gal-3 levels is crucial for improving HF care quality.
Abstract

Keywords:
disease managementgalectin-3heart failureprognosis

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