What question did this study set out to answer?

To determine whether a comprehensive disease management program is superior to usual care in reducing hospitalizations and mortality while improving quality of life in patients with chronic heart failure under universal healthcare.

April 28, 2017BMC MedicineOpen Access

Disease management in the treatment of patients with chronic heart failure who have universal access to health care: a randomized controlled trial

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Why the study?

Does a comprehensive disease management program reduce hospital admission for heart failure exacerbation or death from any cause in adult patients with moderate-to-severe chronic heart failure compared to usual care?

Population

n=1,360 community-dwelling adult patients with moderate-to-severe chronic heart failure who have universal…

Comparison

Disease management program delivered by… vs Usual care treated by primary care practitioners…

Design

RCT, randomly assigned, open-label

Follow-up

median 2.0 years for disease management, 1.8 years for…

Authors

OKOfra Kalter‐LeiboviciTel Aviv University DFDov FreimarkTel Aviv University LFLaurence S. FreedmanSheba Medical Center

Discussion

Member takes

Implication

Comprehensive disease management programs may not reduce hard clinical events in systems with universal healthcare access; leaves open whether.

Key Points

To determine whether a comprehensive disease management program is superior to usual care in reducing hospitalizations and mortality while improving quality of life in patients with chronic heart failure under universal healthcare.
Multicenter open-label randomized controlled trial (NCT00533013) enrolling 1,360 adult patients with moderate-to-severe chronic heart failure recruited post-hospitalization (38%) or from the community (62%).
Participants were randomly assigned to multidisciplinary disease management (education, symptom monitoring, medication titration, and home telemonitoring) or usual care delivered by primary care physicians and cardiologists.
The primary composite endpoint was time to first heart failure hospitalization or all-cause death, evaluated by intention-to-treat analysis adjusted for baseline characteristics and study center over up to 5.0 years.
The primary composite endpoint occurred in 388 (56.9%) patients in the disease management group and 387 (57.1%) in the usual care group (adjusted HR, 0.908; 95% CI, 0.788 to 1.047).
Median time to the primary endpoint or end of study was 2.0 years (range 0–5.0) for disease management versus 1.8 years (range 0–5.0) for usual care.
Hospital admissions were mostly (70%) unrelated to heart failure, while disease management significantly improved health-related quality of life and reduced depression scores during follow-up.

Structured PICO

Population

n=1,360 community-dwelling adult patients with moderate-to-severe chronic heart failure who have universal access to advanced health-care services and technologies, recruited after hospitalization for heart failure exacerbation (38%) or from the community (62%).

Intervention

Disease management program delivered by multi-disciplinary teams, including coordination of care, patient education, monitoring disease symptoms and patient adherence to medication regimen, titration of drug therapy, and home tele-monitoring of body weight, blood pressure and heart rate.

Comparator

Usual care treated by primary care practitioners and consultant cardiologists.

Outcome

Composite of time elapsed till first hospital admission for heart failure exacerbation or death from any cause.composite

A comprehensive disease management program did not significantly reduce the composite of heart failure hospitalization or death compared to usual care in patients with universal healthcare access, though it improved quality of life and depression.

Cite This Study

Kalter‐Leibovici et al. (2017) studied this question.

synapsesocial.com/papers/6a7cbe681b0fae09726eeb8f https://doi.org/10.1186/s12916-017-0855-z

Topics

Heart failure hospitalization Heart failure HFrEF treatment HFpEF management

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Implication

Comprehensive disease management programs may not reduce hard clinical events in systems with universal healthcare access; leaves open whether.

Disease management in the treatment of patients with chronic heart failure who have universal access to health care: a randomized controlled trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Disease management in the treatment of patients with chronic heart failure who have universal access to health care: a randomized controlled trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider