Abstract
BackgroundPatients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, heart failure disease management programs (HFDMPs) have proven effective for reducing readmissions for decompensated heart failure or other cardiovascular causes by up to 30%. However, the benefits of HFDMP in different populations of heart failure patients is unknown.MethodThis observational cohort study compared mortality and readmission in heart failure patients who participated in an HFDMP (HFDMP group) and heart failure patients who received standard care (non-HFDMP group) over a 1-year follow-up period after discharge (December 2014 retrospectively registered). The components of the intervention program included a patient education program delivered by the lead nurse of the HFDMP; a cardiac rehabilitation program provided by a physical therapist; consultation with a dietician, and consultation and assessment by a psychologist. The patients were followed up for at least 1 year after discharge or until death. Patient characteristics and clinical demographic data were compared between the two groups. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HRs) for death or recurrent events of hospitalization in the HFDMP group in comparison with the non-HFDMP group while controlling for covariates.ResultsThe two groups did not significantly differ in demographic characteristics. The risk of readmission was lower in the HFDMP group, but the difference was not statistically significant (HR = 0.36, p = 0.09). In patients with ischemic cardiomyopathy, the risk of readmission was significantly lower in the HFDMP group compared to the non-HFDMP group (HR = 0.13, p = 0.026). The total mortality rate did not have significant difference between this two groups.ConclusionThe HFDMP may be beneficial for reducing recurrent events of heart failure hospitalization, especially in patients with ischemic cardiomyopathy.Trial registrationLongitudinal case-control study ISRCTN98483065, 24/09/2019, retrospectively registered.
Highlights
Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure
The risk of readmission was lower in the Heart failure disease management program (HFDMP) group, but the difference was not statistically significant (HR = 0.36, p = 0.09)
In patients with ischemic cardiomyopathy, the risk of readmission was significantly lower in the HFDMP group compared to the non-HFDMP group (HR = 0.13, p = 0.026)
Summary
Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, the heart failure disease management programs (HFDMPs) led by cardiovascular nursing specialists have proven effective for decreasing adverse outcomes of HF and have achieved HF treatment cost savings of up to 41.8% [3]. These programs can decrease the rate of readmission for HF or other cardiovascular causes by up to 30% and have a trend toward lower mortality rate by a systemic meta-analysis [4]. Some HFDMPs show not improvements in health status compared with standard care [6, 7] Another question is whether HFDMP should be provided to all HF patients or only specific subsets
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