Structured telephone support programs in chronic heart failure may be affected by a learning curve.

Abstract

The efficacy of a telephone support program in chronic heart failure has been questioned particularly when considering short-term follow-up. This study is aimed to assess the impact of the HeartNetCare telephone support program in chronic heart failure within 18 months of observation and to verify a possible effect of a learning-to-care curve on outcome. We retrospectively compared a cohort of 269 chronic heart failure patients included in HeartNetCare program with 200 patients receiving usual care as a control group. All-cause death and hospitalization for heart failure or implantation of left ventricular assist device were the primary composite outcome. Secondary endpoints were the changes in left ventricular ejection fraction and in New York Heart Association (NYHA) functional class. Outcome data were also analyzed in relation to the time of enrollment from program initiation. At baseline, HeartNetCare group showed lower ejection fraction and higher NYHA class. At the follow-up, 59 HeartNetCare patients (21.9%) and 49 usual care patients (24.5%) reached the primary endpoint (P = 0.51). After 18 months of follow-up, HeartNetCare patients improved ejection fraction and NYHA class compared with the usual care patients (P < 0.001). We also observed that the HeartNetCare patients enrolled after 12 months from the initiation of the program had a more favorable outcome in primary endpoint compared with controls. These results indicate that the long-term impact of a structured telephone support program might be able to positively influence symptoms and reduce events in chronic heart failure. These appreciable effects where more evident after an initial period essential for completing the learning-to-care curve.