Abstract
International guidelines for heart failure (HF) care recommend the implementation of inter-professional disease management programmes. To date, no such programme has been tested in Switzerland. The aim of this randomised controlled trial (RCT) was to test the effect on hospitalisation, mortality and quality of life of an adult ambulatory disease management programme for patients with HF in Switzerland. Consecutive patients admitted to internal medicine in a Swiss university hospital were screened for decompensated HF. A total of 42 eligible patients were randomised to an intervention (n = 22) or usual care group (n = 20). Medical treatment was optimised and lifestyle recommendations were given to all patients. Intervention patients additionally received a home visit by a HF-nurse, followed by 17 telephone calls of decreasing frequency over 12 months, focusing on self-care. Calls from the HF nurse to primary care physicians communicated health concerns and identified goals of care. Data were collected at baseline, 3, 6, 9 and 12 months. Mixed regression analysis (quality of life) was used. Outcome assessment was conducted by researchers blinded to group assignment. After 12 months, 22 (52%) patients had an all-cause re-admission or died. Only 3 patients were hospitalised with HF decompensation. No significant effect of the intervention was found on HF related to quality of life. An inter-professional disease management programme is possible in the Swiss healthcare setting but effects on outcomes need to be confirmed in larger studies.
Highlights
As the incidence and prevalence of cardiovascular diseases are steadily increasing globally, new and more efficient care for these patients is needed
Following 1:1 randomisation for assignment to TIME-CHF or Swiss Interdisciplinary Management Programme for Heart Failure (SWIMHF), 140 patients were contacted to participate in the study
In addition to the efficacy of an inter-professional Heart failure (HF) disease management programme in Switzerland, questions have been previously raised as to whether such a programme would be accepted by primary care physicians, whether patients would agree to participate, and whether the intervention, or self-care procedures, would be too burdensome for these very ill patients
Summary
As the incidence and prevalence of cardiovascular diseases are steadily increasing globally, new and more efficient care for these patients is needed. Heart failure (HF), the end stage condition for at least 10% of all patients with heart disease, presents a particular challenge for healthcare systems as patients with HF are primarily aged, have a high symptom burden and are susceptible to frequent, acute decompensation, subsequent re-admissions to hospital and have a high mortality [1]. Annual costs incurred by HF are estimated to represent approximately 2% of the total healthcare budget [6]. Hospital re-admission rates after an admission for HF are high, as 9% will be admitted within 1 week, 23% of the patients will be admitted within a month
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