Primary care-based integrated disease management for heart failure: a study protocol for a cluster randomised...

Area of Science:

• Cardiology
• Primary Care Medicine
• Health Services Research

Background:

• Heart failure (HF) is a prevalent chronic disease associated with high hospitalization rates, reduced quality of life, and increased mortality.
• Effective management of HF is complex, with most patient interactions occurring within primary care settings.
• While disease management programs post-hospitalization show benefits, evidence for integrated disease management (IDM) in primary care HF populations remains less conclusive.

Purpose of the Study:

• To evaluate the efficacy of an integrated disease management (IDM) program for a high-risk primary care heart failure (HF) population.
• The IDM program focuses on optimizing medication, enhancing patient self-management skills, and providing structured follow-up.
• To assess the impact of IDM on key health outcomes and service utilization in primary care HF patients.

Main Methods:

• A multicentre cluster randomized controlled trial involving 100 family physician clusters in Canadian primary care.
• Physicians were randomized to either the IDM program or usual care.
• The IDM program involved collaborative care between family physicians and trained HF educators, including case management, medication management, and patient education.

Main Results:

• The primary outcome measured the combined rate of all-cause hospitalizations, emergency department visits, and mortality over a 12-month follow-up.
• Secondary outcomes included health service utilization, quality of life, and acute HF episodes.
• The study was powered to detect a 35% reduction in the primary outcome with 90% power.

Conclusions:

• The study aims to provide evidence on the effectiveness of IDM in improving outcomes for high-risk primary care HF patients.
• Findings will inform the implementation of optimized HF management strategies within primary care settings.
• Dissemination includes local reports, presentations, and peer-reviewed publications to share study results.