Outcome of Patients Discharged From a Heart Failure Disease Management Program following Their Clinical and Echocardiographic Recovery

OBJECTIVES: Heart failure (HF) is associated with high mortality and frequent hospitalizations. Disease management programs (DMPs) have a favorable impact on patients with HF. No data exist regarding the outcomes of patients discharged from such a program. METHODS: We examined the outcome of patients with severe systolic HF who were discharged from a DMP following full clinical and echocardiographic recovery. Data were reviewed for mortality, emergency room visits, hospitalizations, medication adherence and left ventricular ejection fraction (EF). RESULTS: At enrollment and discharge, the mean EF was 19 and 53%, respectively. At follow-up 46.2 months after discharge, 56% of patients had been to the emergency room, 34% were hospitalized a total of 41 times and 20% had died. In the patients who required hospitalization for HF, the mean EF upon rehospitalization had dropped to 23.4%. CONCLUSIONS: Many patients with initially severe systolic HF who had an almost full recovery in a multidisciplinary DMP had very poor outcomes once they were discharged from the program. It may be appropriate to revisit the practice of discharging patients from DMPs once they have reached a specific clinical target.