Effectiveness of a disease management program in heart failure is influenced by patient's prior hospitalisation

Abstract

Abstract Background Hospitalization due to heart failure (HF) is a strong predictor of adverse outcomes. This study sought to what extent previous HF admissions may affect the success of a disease management program (DMP). Methods We prospectively enrolled 1363 consecutive HF patients, who were followed for 3 months post-discharge. Of these, 431 (31%) received a DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review). Study outcomes were all-cause readmission or death at 30- and 90-day post-discharge. Previous HF admissions were collected from medical records. Results Of 1363 HF patients, death or readmission occurred in 386 (28%) at 30-day and 556 (41%) at 90-day post-discharge. Compared to 765 patients without any previous admission, the 143 patients with a previous HF admission in >12 months had similar risks of readmission or death at 30-day and 23% higher risks at 90-day. The 420 patients who had a previous HF admission in ≤12 months had higher risks of the composite outcome both at 30-day (RR=1.47 [1.23–1.76]) and 90-day (RR=1.49 [1.30–1.69]). DMP was not associated with any reductions in adverse outcomes at 30-day and 90-day among patients with a previous HF admission in ≤12 months, but was significantly associated with up to a 75% reduction in risks at 30-day and a 50% reduction in risks at 90-day among those without an admission in ≤12 months. These findings were independent of all other factors. Conclusion Higher levels of attention should be focused on HF patients with a recent prior HF admission who have higher risks of post-discharge adverse outcomes and appear to be non-responsive to a DMP to reduce readmission. Funding Acknowledgement Type of funding sources: None.