Details

Autor(en) / Beteiligte

• Tsuyuki, Ross T.
• Fradette, Miriam
• Johnson, Jeffrey A.
• Bungard, Tammy J.
• Eurich, Dean T.
• Ashton, Thomas
• Gordon, Wendy
• Ikuta, Roland
• Kornder, Jan
• Mackay, Elizabeth
• Manyari, Dante
• O’Reilly, Ken
• Semchuk, William
• for the react investigators

Titel

A multicenter disease management program for hospitalized patients with heart failure

Ist Teil von

• Journal of cardiac failure, 2004-12, Vol.10 (6), p.473-480

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2004

Quelle

MEDLINE

Beschreibungen/Notizen

• Despite the availability of proven therapies, outcomes in patients with heart failure (HF) remain poor. In this 2-stage, multicenter trial, we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF. In Stage 1, a pharmacist or nurse assessed each patient and made recommendations to the physician to add or adjust angiotensin-converting enzyme (ACE) inhibitors and other HF medications. Before discharge (Stage 2), patients were randomized to a patient support program (PSP) (education about HF, self-monitoring, adherence aids, newsletters, telephone hotline, and follow-up at 2 weeks, then monthly for 6 months after discharge) or usual care. In Stage 1 (766 patients) ACE inhibitor use increased from 58% on admission to 83% at discharge ( P < .0001), and the daily dose (in enalapril equivalents) increased from 11.3±8.8 mg to 14.5±8.8 mg ( P < .0001). In Stage 2 (276 patients) there was no difference in ACE inhibitor adherence, but a reduction in cardiovascular-related emergency room visits (49 versus 20, P = .030), hospitalization days (812 versus 341, P = .003), and cost of care ($CDN 2,531 less per patient) in favor of the PSP. Simple interventions can improve ACE inhibitor use and patient outcomes.