Improved outcomes from a comprehensive management system for heart failure

Aims: Congestive heart failure (CHF) is associated with a high readmission rate after diagnosis. We assessed the ability of a comprehensive management program (CMP) for CHF to reduce readmissions with secondary endpoints of improving quality of life, exercise capacity and targeted drug doses. Methods and results: Patients (pts) with: New York Heart Association Class (NYHA) III or IV CHF; left ventricular ejection fraction < 40%; and stable outpatient therapy were assigned to a CMP of cardiology assessment intensive education and referral to a tailored exercise program. Forty-two pts (35 M, 7 F, mean age 54 years, S.D. 12 years) were enrolled. Two pts were transplanted, two died during follow-up and two were lost to follow-up. Hospital admissions were reduced by 87.2%, (mean 1.05, S.D. 0.98, admissions per pt to mean 0.08, S.D. 0.28, admissions per pt at 6-month follow-up; P < 0.0001). ACE-inhibitor dose increased by 42% (P < 0.0008) and beta-blocker dose increased by 61% (P < 0.0001). NYHA Class, 6-min walk and quality of life scores all improved significantly (P < 0.0001). Conclusion: A CMP improves QOL and exercise capacity as well as substantially reducing hospital admissions in CHF pts. This study validates the benefit of intensive outpatient care of CHF.