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February 11, 2008Archives of Internal Medicine

Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart FailureCoordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)

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Why the study?

Does additional basic or intensive support by a heart failure nurse reduce time to death or HF rehospitalization and days lost to death or hospitalization in patients recently hospitalized for heart failure?

Population

1023 patients enrolled after hospitalization because of heart failure, mean age 71 years, 38% women, 50%…

Comparison

Additional basic or intensive support by a nurse… vs Standard follow-up by a cardiologist.

Design

RCT, randomized

Follow-up

18 months

Authors

TJTiny Jaarsma

Discussion

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Overview

Nurse-led support programs do not reduce death or HF readmission; confirms standard cardiologist follow-up suffices without added interventions.

Key Points

  • Evaluate the effectiveness of moderate and intensive disease management programs in reducing adverse outcomes in heart failure patients.
  • Multicenter, randomized, controlled trial with 1023 patients hospitalized for heart failure.
  • Patients assigned to control group or two intervention groups with varying nurse support.
  • Followed for 18 months with primary endpoints related to death and rehospitalization.
  • 40% of patients were readmitted or died, with 42% in control and 41% in basic, 38% in intensive support groups (HR 0.96, HR 0.93).
  • Days lost to hospitalization were similar across groups, with control at 39,960 days, basic at 33,731 days, and intensive at 34,268 days.
  • Mortality was 29% in control, showing a trend toward lower in intervention groups (HR 0.85, 95% CI 0.66-1.08, P=0.18).

Structured PICO

Does additional basic or intensive support by a heart failure nurse reduce time to death or HF rehospitalization and days lost to death or hospitalization in patients recently hospitalized for heart failure?

P
Population
1023 patients enrolled after hospitalization because of heart failure, mean age 71 years, 38% women, 50% with mild HF and 50% with moderate to severe HF.
I
Intervention
Additional basic or intensive support by a nurse specializing in management of patients with heart failure over 18 months.
C
Comparator
Standard follow-up by a cardiologist.
O
Outcome
Time to death or rehospitalization because of HF and the number of days lost to death or hospitalization at 18 months.composite

Disease management programs by specialized heart failure nurses did not significantly reduce death or heart failure hospitalizations compared to standard cardiologist follow-up in patients recently hospitalized for heart failure.

Cite This Study

Tiny Jaarsma (2008) studied this question.

synapsesocial.com/papers/69f690ffe405cc4465bc2a1bhttps://doi.org/10.1001/archinternmed.2007.83
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