Heart Failure Disease Management Programs

Abstract

Heart failure (HF) remains a major public health problem that affects 5 million patients in the United States.1 HF is the leading cause of hospitalization for people 65 years of age and older, and rates of hospital readmission within 6 months range from 25% to 50%.1,2 The personal burden of HF includes debilitating symptoms, frequent rehospitalizations, and high rates of mortality.2 HF also poses a substantial economic burden, with annual direct costs for the care of HF patients estimated to be between $20 billion and $56 billion.1–3 A number of studies have documented marked variation in the quality of care judged by specific performance measures and substantial underuse of evidence-based, guideline-recommended HF therapies in patients receiving conventional care.2,4,5 Moreover, patient behavioral factors (such as nonadherence to diet and medications) and economic and social factors frequently contribute to rehospitalizations.2,5,6 The traditional model of care delivery is thought to contribute to frequent hospitalizations because in these brief episodic encounters, little attention may be paid to the common modifiable factors that precipitate many hospitalizations.6 As such, there has been much interest in identifying effective methods to improve the quality of care for HF patients while reducing costs. See p 3518 We and others first studied the use of comprehensive HF management programs involving specialty care and a multidisciplinary team; the goals of the HF disease management (DM) programs included optimization of drug therapy, intensive patient education, vigilant follow-up with early recognition of problems, and identification and management of patients’ comorbidities.7–9 HF patients who were cared for in these programs were shown to have significantly fewer rehospitalizations, lower healthcare costs, improved functional and symptom status, and better quality of life as compared either with their preintervention status or with HF patients being treated with conventional care. …