What question did this study set out to answer?

Evaluate the effectiveness of moderate and intensive disease management programs in reducing adverse outcomes in heart failure patients.

February 11, 2008

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)

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).

Abstract

BACKGROUND: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent. METHODS: The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization. RESULTS: Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P = .81), and 34 268 for the intensive support group (P = .49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P = .89; and intensive support group, P = .60). CONCLUSIONS: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups. Clinical Trial Registry http://trialregister.nl Identifier: NCT 98675639.

Mark Helpful

Bookmark

Relay