Heart Failure Management Programs Research Articles

Carers' views on patient self-care in chronic heart failure.

To examine carers' views on patient self-care in chronic heart failure (CHF). Self-care, a key strategy in the long-term management of CHF, can be complex and difficult to master. Carers play a key role in supporting patients in self-care, yet their views on it are rarely sought. A qualitative approach was adopted with a purposeful sample of carers of patients with CHF residing in Australia. Carers who identified themselves as providing informal care to a person diagnosed with chronic heart failure were interviewed about their views on patient self-care. Data were collected by face-to-face interviews with a semi-structured interview guide. Qualitative content analysis of the interviews was undertaken by two nurses and one psychologist. Four key themes were identified pertaining to CHF patient self-care: hindrance to engagement; roles and relationships; social support and community engagement and competency. Most carers viewed patients' fatigue and inactivity, mood and coping, and memory loss as major challenges to engagement in self-care. They viewed emotional support and encouragement, independence and organised routines as important aspects of their relationship with the patient and as facilitators of self-care, but also required for themselves support from their families, communities and healthcare professionals. They also viewed patient and carer experience and knowledge as being essential to successful self-care. Carers viewed self-care as an important issue for patients with CHF and indicated that they could play an enhanced role with the provision of better support and knowledge from their families, communities and health care professionals. Carers are closely involved in supporting patients in CHF self-care, even though their views are rarely considered in the organisation and delivery of heart failure management programmes. Therefore, their important contribution should be acknowledged and supported in contemporary heart failure health services.

An evidence-based outpatient heart failure management program to improve patient self-care and reduce readmissions

An evidence-based outpatient heart failure management program to improve patient self-care and reduce readmissions

Detecting Heart Failure Decompensation by Measuring Transthoracic Bioimpedance in the Outpatient Setting: Rationale and Design of the SENTINEL-HF Study.

BackgroundRecurrent hospital admissions are common among patients admitted for acute decompensated heart failure (ADHF), but identification of patients at risk for rehospitalization remains challenging. Contemporary heart failure (HF) management programs have shown modest ability to reduce readmissions, partly because they monitor signs or symptoms of HF worsening that appear late during decompensation. Detecting early stages of HF decompensation might allow for immediate application of effective HF therapies, thereby potentially reducing HF readmissions. One of the earliest indicators of HF decompensation is intrathoracic fluid accumulation, which can be assessed using transthoracic bioimpedance.ObjectiveThe SENTINEL-HF study is a prospective observational study designed to test a novel, wearable HF monitoring system as a predictor of HF decompensation among patients discharged after hospitalization for ADHF.MethodsSENTINEL-HF tests the hypothesis that a decline in transthoracic bioimpedance, as assessed daily with the Philips fluid accumulation vest (FAV) and transmitted using a mobile phone, is associated with HF worsening and rehospitalization. According to pre-specified power calculations, 180 patients admitted with ADHF are enrolled. Participants transmit daily self-assessments using the FAV-mobile phone dyad for 45 days post-discharge. The primary predictor is the deviation of transthoracic bioimpedance for 3 consecutive days from a patient-specific normal variability range. The ADHF detection algorithm is evaluated in relation with a composite outcome of HF readmission, diuretic up-titration, and self-reported HF worsening (Kansas City Cardiomyopathy Questionnaire) during a 90-day follow-up period. Here, we provide the details and rationale of SENTINEL-HF.ResultsEnrollment in the SENTINEL-HF study is complete and the 90-days follow-up is currently under way. Once data collection is complete, the study dataset will be used to evaluate our ADHF detection algorithm and the results submitted for publication.ConclusionSENTINEL-HF emerged from our long-term vision that advanced home monitoring technology can improve the management of chronic HF by extending clinical care into patients’ homes. Monitoring transthoracic bioimpedance with the FAV may identify patients at risk of recurrent HF decompensation and enable timely preventive measures.Trial RegistrationClinicaltrials.gov NCT01877369: https://clinicaltrials.gov/ct2/show/NCT01877369 (Archived by WebCite at http://www.webcitation.org/6bDYl0dGy)

Addressing the conundrum of multimorbidity in heart failure: Do we need a more strategic approach to improve health outcomes?

There is clear evidence across the globe that the clinical complexity of patients presenting to hospital with the syndrome of heart failure is increasing - not only in terms of the presence of concurrent disease states, but with additional socio-demographic risk factors that complicate treatment. Management strategies that treat heart failure as the main determinant of health outcomes ignores the multiple and complex issues that will inevitably erode the efficacy and efficiency of current heart failure management programmes. This complex problem (or conundrum) requires a different way of thinking around the complex interactions that underpin poor outcomes in heart failure. In this context, we present the COordinated NUrse-led inteNsified Disease management for continuity of caRe for mUltiMorbidity in Heart Failure (CONUNDRUM-HF) matrix that may well inform future research and models of care to achieve better health outcomes in this rapidly increasing patient population.

Abstract 12158: Population Thresholds for Systematically Applying Nurse-Led Chronic Heart Failure Management Programs to Reduce Recurrent Hospitalization and Prolong Survival

Background: In many countries, a jurisdictional (regional or health fund membership) approach to applying nurse-led, multidisciplinary management programs for high risk individuals hospitalized with chronic heart failure (CHF) has led to their inconsistent application. A health service perspective was therefore used to determine the overall value of funding services for a whole population. Methods: Data from a contemporary study of the burden of CHF in Australia (population ~ 24 million of whom ~25% live in regional settings) to identify the number of de novo admissions for CHF per annum (n=19,397) were used. From these we estimated the proportion of cases readmitted (63% - all cause), days of related hospitalization (44,500 days from 5,300 admissions) and case-fatality (27%) within 12 months. Health economic data from a recent multicentre trial of CHF management were then applied to estimate the cost impact ($US) of applying gold-standard management to de novo CHF cases. Results: Total health care expenditure (excluding index admission and incremental CHF management) for managing de novo cases of CHF is estimated at ~$300 million/annum. Of this total, $240 million (68%) is attributable to hospital care plus device-based therapies. Applying nurse-led multidisciplinary CHF management to all cases (with up-titration of therapy and increased face-to-face and remote contacts as required) would cost ~ $35 million/annum. In order to achieve a cost-neutral state, this service would need to achieve a minimum reduction of 6,500 days (15% reduction) in recurrent hospital stay (all cause). At proven, evidence-based thresholds of impact, a 20% - 30% reduction in recurrent hospital stay would provide annual savings of $12 - 35 million/annum. A one third reduction in mortality at 12 months would also result in 2,100 lives saved at a minimum cost >$17,000 per annum (neutral impact on recurrent hospital stay). Conclusions: These data provide a compelling case for adopting a whole population/health care system approach to systematically applying CHF management programs to reduce recurrent hospital stay and mortality in de novo cases of CHF.

Interventions to prevent heart failure readmissions: The rationale for nurse-led heart failure programs

Background: Readmission to hospitals for heart failure is one of the greatest economic burdens on Medicare, and has become a major focus of healthcare reform. In an attempt to stem the overwhelming number of readmissions and improve heart failure outcomes, hospitals have employed multiple interventions. Nurse-led heart failure management programs have been an effective strategy in reducing hospital readmissions for heart failure. Purpose: We conducted an integrative review of the literature that assessed the value of interventions to reduce heart failure readmission rates. We focused on the important role of nursing care in successfully implementing many of these interventions. Methods: An integrative review of the literature was performed. A computerized search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library (reviews and clinical trials) was performed to locate articles published from 2004 to 2014. Key words used included “heart failure nursing” , “heart failure readmissions”, “heart failure programs” and “interventions for heart failure readmission”. Preference was placed on articles published in the last 10 years. Articles referenced by national heart failure guideline documents and expert consensus statements were given a high priority. Eighty-eight articles were screened initially by two reviewers; these were then screened to leave 40 relevant articles. Conclusions: Several specific interventions have a proven favorable effect in reducing heart failure readmissions. These include optimal medical management, patient education and self-care instruction, and ensuring adequate post-discharge follow-up. Despite this knowledge there remains a wide variation of readmission rates across the U nited S tates . This may be partly due to the variability in the adequate implementation of interventions and/or the absence of a required number of interventions in different centers. Each single intervention in itself has only a very small beneficial effect. The implementation of several interventions is essential to produce a meaningful reduction in heart failure readmissions. The ability to successfully employ numerous interventions together may explain the promising results of structured nurse-led heart failure programs.

The importance of interactions between patients and healthcare professionals for heart failure self-care: A systematic review of qualitative research into patient perspectives.

Effective heart failure (HF) self-care can improve clinical outcomes but is dependent on patients' undertaking a number of complex self-care behaviors. Research into the effectiveness of HF management programs demonstrates mixed results. There is a need to improve understanding of patient perspectives' of self-care need in order to enhance supportive interventions. This paper reports selected findings from a systematic review of qualitative research related to HF self-care need from the patients' perspective. The focus here is on those facets of patient-healthcare professional relationships perceived by patients to influence HF self-care. We searched multiple healthcare databases to identify studies reporting qualitative findings with extractable data related to HF self-care need. Joanna Briggs Institute systematic review methods were employed and recognized meta-synthesis techniques were applied. Critical realist theory provided analytical direction to highlight how individual and contextual factors came together in complex ways to influence behavior and outcomes. Altogether 24 studies (1999-2012) containing data on patient-healthcare professional relationships and HF self-care were included. Interaction with healthcare professionals influenced self-care strongly but was notably mixed in terms of reported quality. Effective HF self-care was more evident when patients perceived that their healthcare professional was responsive, interested in their individual needs, and shared information. Poor communication and lack of continuity presented common barriers to HF self-care. Interactions and relationships with clinicians play a substantial role in patients' capacity for HF self-care. The way healthcare professionals interact with patients strongly influences patients' understanding about their condition and self-care behaviors.

Knowledge is insufficient for self-care among heart failure patients with psychological distress.

We conducted a study to identify barriers to, and factors promoting, self-care among heart failure (HF) patients with higher or lower levels of knowledge. Baseline data from 612 patients with HF enrolled in the REMOTE-HF trial were analyzed. Using median splits on the HF Knowledge Scale and the European HF Self-Care Behavior Scale, patients were divided into four groups: (a) low knowledge and good self-care, (b) low knowledge and poor self-care, (c) high knowledge and good self-care, and (d) high knowledge and poor self-care. Characteristics of the groups were compared using ANOVA, Kruskal-Wallis tests, and chi-square tests, followed by pairwise tests with Bonferroni correction. Variables significant in the univariate analyses were evaluated as predictors of self-care using hierarchical multiple linear regression. The potential moderating effect of knowledge was tested with interaction terms. The four groups did not differ in sociodemographics or health literacy scores, but differed in New York Heart Association (NYHA) class, comorbidities, and scores on depression, anxiety, and perceived control. In post hoc pairwise tests, patients with high knowledge and poor self-care tended to have worse NYHA class, greater depression and anxiety, and lower levels of perceived control than others. In the multivariate analysis, knowledge, depressive symptoms, and perceived control were significant predictors of self-care, as was the interaction between knowledge and anxiety. Screening and treatment of depression and anxiety is important in improving self-care among HF patients. HF management programs need to include strategies for increasing patients' perceived control over their heart disease.

Abstract 253: Bottom up Costing Ventricular Assist Device Therapy And Optimal Medical Management-first Steps To Establishing Cost Effectiveness.

Background: Since Left Ventricular Assist Devices were approved in the US for destination therapy, there has been a rapid increase in their use. Information on the cost of advanced heart failure management (AHF), transplant (HTX) and VAD programs is variable across health systems, as most cost data is derived from casemix costing, charges or claims against insurers. This weakens comparative studies as eligible AHF patients are cost outliers in the broader heart failure population. We outline a cost effectiveness study of VAD therapy vs AHF as part of an HTX program, using Time Driven Activity Based Costing of identified models of care in an Australian setting. Methods: All patients activated to the HTX waitlist between 07/2009 and 06/2012 (n=101) were screened and 86 included (62 AHF, 24 VAD). Models of care were defined through 13/86 file reviews, clinician interviews and analysis of activity. Detailed costing was undertaken for 5 VAD and 8 AHF patients for 12 months pre and post HTX listing or VAD implant and included medical, allied health, nursing activities, inpatient care and clinic visits (ClinV), consumables, drugs, pathology, medical imaging, and prosthetics. Results: Mortality at 1 yr was 12% (3/24) for VADs post implant and 11% (7/62) for AHF post HTX activation. 148 service activities were identified in 13 file reviews ranging from basic documentation to ECMO insertion. The two groups were matched for age, AHF etiology and gender. In house database interrogation yielded a median pathology cost per patient of $4811 in 17/24 Pre VAD, and $12,294 in 20/24 Post VAD patients,. Median allied Health cost for 19/24 Pre VAD patients was $545 and in 23/24 Post VAD was $2938 ($AUD) Hospitalisations and costs borne beyond the transplant center made comparison between VAD therapy and AHF incomplete. Conclusion: The BTT VADs were sicker, with more days hospitalized pre and post VAD. From an institutional and health system perspective, correct identification of, and reimbursement for activities related to best practice models of care is crucial. Cost effectiveness, capturing costs borne at other hospitals as well as federal, drug and GP reimbursements should be addressed in this cohort.

Education material for heart failure patients: what works and what does not?

Patient education is an important element of care, but evidence with regard to education material is not always apparent, as it is intertwined with educational strategies as components of heart failure management programs. Difficulties have arisen in determining the effectiveness of particular education strategies, as multiple strategies are commonly bundled together and packaged within research protocols. To further complicate this issue, the bundles are diverse, lack precision in describing their components, and report different outcomes. Despite these difficulties, clinicians can utilise a number of proven commonalities to deliver effective education: assessment of learning needs and style, verbal interaction with a healthcare professional, and a selection of multimedia patient education materials.

Efficacy of an Integrated Hospital-primary Care Program for Heart Failure: A Population-based Analysis of 56 742 Patients

Introduction and objectivesThe efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309 345. MethodsFor the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service). ResultsWe included 56 742 patients in the study. There were 181 204 hospital admissions and 30 712 deaths during the study period. In the adjusted analyses, when compared to the 54 659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio=0.92 [95% confidence interval, 0.86-0.97]; P=.005), a lower risk of clinically-related readmission (hazard ratio=0.71 [95% confidence interval, 0.66-0.76]; P<.001), and a lower risk of readmission for heart failure (hazard ratio=0.86 [95% confidence interval, 0.80-0.94]; P<.001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established. ConclusionsThe implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality.

Eficacia de un programa integrado hospital-atención primaria para la insuficiencia cardiaca: análisis poblacional sobre 56.742 pacientes

Introduction and objectivesThe efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309 345. MethodsFor the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service). ResultsWe included 56 742 patients in the study. There were 181 204 hospital admissions and 30 712 deaths during the study period. In the adjusted analyses, when compared to the 54 659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio=0.92 [95% confidence interval, 0.86-0.97]; P=.005), a lower risk of clinically-related readmission (hazard ratio=0.71 [95% confidence interval, 0.66-0.76]; P<.001), and a lower risk of readmission for heart failure (hazard ratio=0.86 [95% confidence interval, 0.80-0.94]; P<.001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established. ConclusionsThe implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality.Full English text available from: www.revespcardiol.org/en

Integration of remote monitoring of device diagnostic parameters into a multidisciplinary heart failure management program

Integration of remote monitoring of device diagnostic parameters into a multidisciplinary heart failure management program

The Year in Cardiology 2013: heart failure

Heart failure has become a worldwide epidemic of the 21st century with increasing impact on healthcare systems. The 2012 ESC and 2013 ACCF/AHA guidelines have set the stage for current therapy to reduce mortality and morbidity. There is a dawn of hope for therapy of acute and diastolic heart failure; it has become clearer that patients benefit from mitral reconstruction and which patients benefit from heart failure management programmes; genetics and proteomics advance in great strides; competing concepts of cell therapy seem to spiral, hopefully upwards; and we can further nurture our hope for evidence-based individualized diagnostic and therapy.

High complexity chronic heart failure management programmes: Programme characteristics and 12 month patient outcomes

Chronic heart failure management programmes (CHF-MPs) have been developed to improve, clinical outcomes in response to the high burden of disease from chronic heart failure (CHF). Programmes vary in model, duration, complexity of interventions and incorporation of evidence-based guidelines for programme delivery. Few studies have explored patient outcomes at 12 months from enrolment in a CHF. The aim of the current study was to explore the characteristics and clinical outcomes of patients enrolled in four high complexity CHF-MPs at 12 months after initial enrolment. A secondary aim was to explore the adoption of key evidence-based CHF management strategies in these programmes. After ethics approval, a multisite mixed methods design was implemented incorporating survey and chart audit. Programme characteristics and interventions used in four CHF-MPs were surveyed in Stage 1. Stage 2 involved a chart audit of patients enrolled in the programmes (N = 135) on or after the 1/1/07. Primary endpoints were all-cause hospitalisation and/or mortality at 12 months. Data were analysed using descriptive and inferential statistics. All programmes implemented a high complexity of evidence-based interventions consistent with national guidelines. However, documentation of New York Heart Association functional class was rare; limiting quantifiable evaluation of response to therapy throughout programme enrolment. The majority of patients (73%) had severe systolic heart failure with high co-morbidities reflected in a mean Charlson's total co-morbidity score of 3 (± 2.1). The high rate of baseline evidence-based, pharmacothe- rapy (beta-blocker: 86%, n = 112 and ACE inhibitor: 76%, n = 103) was maintained at 12 months (71% and 84% respectively). At 12 months all cause hospitalisation and/or mortality was 57% (n = 77). The CHF-MPs in this study implemented complex evidence-based interventions resulting in high rates of key medication prescription. However, despite the implementation of several evidence-based interventions, over a period of 12 months, more than half of the patients were rehospitalised or died.

Evaluation of the efficacy and costs impact of a telemonitoring and teleintervention trough videoconference program for patients with chronic heart failure: a randomized controlled trial

Background: While telemonitoring has not shown clear benefits, heart failure (HF) management programs had. It is unknown whether a management program based on telemedicine provides advantages compared to conventional management on a HF program. Objectives: Evaluate efficacy and costs benefits of a HF management program using telemedicine compared to standard HF management program. Methods: Prospective, randomized, controlled trial comparing two management strategies of high risk HF patients: HFP (heart failure programme) or HFP+T (heart failure programme based on telemedicine). Telemedicine management consisted in daily telemonitoring of weight, blood pressure, heart rate and symptoms that were transmitted to a central station controlled by HF nurses. Teleintervention was carried out replacing the physical appointments by videoconference, promoting self-care and performing therapeutic optimization. The determination of direct costs was performed using cost accounting methodology. Primary end-point: non-fatal HF events by requiring hospital attention at 6 months of inclusion (decompensations requiring parenteral treatment). Results: A preliminary analysis of the first 74 patients included was performed. Baseline characteristics: mean age was 77 years; 46, 2% were women, 51.3% had preserved LVEF, 50% were in NYHA class III-IV. From 74 patients, 37 were assigned to HFP and 41 to HFP+T. After a follow-up of 6 months, HFP+T group experienced a significant reduction in the primary endpoint and a favorable trends in morbidity and mortality. HF non-fatal event rate, HF readmission rate and mortality rates were 22% (p:0.007), 14.6% (p: 0.09) and 9.8% (p:0.39) respectively. In Cox analysis adjusted for covariates, HFP+T group assignment was a risk reduction of the combined endpoint (all-cause death or HF nonfatal events) (HR 0.36 95% CI [0.17 to 0, 76], P=0.008). Total direct cost of the cohort studied was €666,829 (8,863 per patient ±€1,423). The average cost per patient was significantly lower in the HFP+T group compared with HFP group (4.350±1.257€ vs. 13.625±2.378€; p<0.001) with a mean difference per patient between the two groups of 9274 ±€2,650. Conclusions: Addition of telemedicine to a HF program means: (1) a significant reduction in the number and rate of HF-nonfatal events and also risk reduction of the combined endpoint (all-cause death or HF nonfatal event) with a positive trend in terms of morbidity and mortality. (2) a significant reduction of health costs. The magnitude of the observed reduction suggests their implementation is cost-effective with a quick return in economic terms.

Characterization of acute heart failure hospitalizations in a Portuguese cardiology department

Introduction and AimsWe describe the clinical characteristics, management and outcomes of patients hospitalized with acute heart failure in a south-west European cardiology department. We sought to identify the determinants of length of stay and heart failure rehospitalization or death during a 12-month follow-up period. Methods and ResultsThis was a retrospective cohort study including all patients admitted during 2010 with a primary or secondary diagnosis of acute heart failure. Death and readmission were followed through 2011.Of the 924 patients admitted, 201 (21%) had acute heart failure, 107 (53%) of whom had new-onset acute heart failure. The main precipitating factors were acute coronary syndrome (63%) and arrhythmia (14%). The most frequent clinical presentations were heart failure after acute coronary syndrome (63%), chronic decompensated heart failure (47%) and acute pulmonary edema (21%). On admission 73% had left ventricular ejection fraction <50%. Median length of stay was 11 days and in-hospital mortality was 5.5%. The rehospitalization rate was 21% and 24% at six and 12 months, respectively. All-cause mortality was 16% at 12 months. The independent predictors of rehospitalization or death were heart failure hospitalization during the previous year (Hazard ratio − HR − 3.177), serum sodium <135mmol/l on admission (HR 1.995) and atrial fibrillation (HR 1.791). Reduced left ventricular ejection fraction was associated with a lower risk of rehospitalization or death (HR 0.518). ConclusionsOur patients more often presented new-onset acute heart failure, due to an acute coronary syndrome, with reduced left ventricular ejection fraction. Several predictive factors of death or rehospitalization were identified that may help to select high-risk patients to be followed in a heart failure management program after discharge.

Characterization of acute heart failure hospitalizations in a Portuguese cardiology department

Introduction and AimsWe describe the clinical characteristics, management and outcomes of patients hospitalized with acute heart failure in a south-west European cardiology department. We sought to identify the determinants of length of stay and heart failure rehospitalization or death during a 12-month follow-up period. Methods and ResultsThis was a retrospective cohort study including all patients admitted during 2010 with a primary or secondary diagnosis of acute heart failure. Death and readmission were followed through 2011.Of the 924 patients admitted, 201 (21%) had acute heart failure, 107 (53%) of whom had new-onset acute heart failure. The main precipitating factors were acute coronary syndrome (63%) and arrhythmia (14%). The most frequent clinical presentations were heart failure after acute coronary syndrome (63%), chronic decompensated heart failure (47%) and acute pulmonary edema (21%). On admission 73% had left ventricular ejection fraction <50%. Median length of stay was 11 days and in-hospital mortality was 5.5%. The rehospitalization rate was 21% and 24% at six and 12 months, respectively. All-cause mortality was 16% at 12 months. The independent predictors of rehospitalization or death were heart failure hospitalization during the previous year (Hazard ratio − HR − 3.177), serum sodium <135mmol/l on admission (HR 1.995) and atrial fibrillation (HR 1.791). Reduced left ventricular ejection fraction was associated with a lower risk of rehospitalization or death (HR 0.518). ConclusionsOur patients more often presented new-onset acute heart failure, due to an acute coronary syndrome, with reduced left ventricular ejection fraction. Several predictive factors of death or rehospitalization were identified that may help to select high-risk patients to be followed in a heart failure management program after discharge.

Abstract 146: Medical Home Model in the management of Heart Failure

Purpose: Heart failure (HF) continues as the most expensive diagnosis to manage in the US. Patient failure to adhere to medication regimens and fluid overload have been identified as causative factors in frequent exacerbations requiring hospitalization. This study was designed to evaluate outcomes over time of a Medical Home interdisciplinary team management and patient education design compared to standard of care in HF. Methods: The study was designed as a prospective case-control study. Enrollment occurred post HF hospitalization. During hospitalization all pts received education in Guideline-driven management of HF, and were discharged on evidence-based medications. Patients provided informed consent allowing review of medical records for 5 years. One group of pts agreed to participate in a Medical Home for the management of HF (MHHF) while another group chose management of HF by their own cardiologists. Data analysis was performed using case controlled pairing of pts based on age, gender and socio-economic status. Data represents results at 48 months. The Intervention group (22 pts: mean age 60.8) was followed in a MHHF which includes a HF specific clinic and a 12 week comprehensive HF management and exercise program (both clinic and HF management program have the same disease management protocols) and the Control group (48 pts: mean age 62.2) returned to standard follow up care for HF. In MHHF medications were optimized per evidence -based recommendations and education included use of medications, diet and effective sodium balance. Results: Functional Capacity Results: Medication adherence/Hospitalizations/ED visits Note: * baseline to 48 months. Hosp. visits = # hospitalizations/yr/ patient, ED Visits = # ED visits/yr/ patient. Medical record review of medication use for Standard of Care pts failed to provide adequate information on dose /patient. **Adherence was often self reported so true adherence may be lower than reported for this group. Conclusions: 1. Patients participating in MHHF demonstrated long-term improvement in medication adherence and smoking cessation. 2. Patients participating in MHHF demonstrated significantly fewer HF related Hospitalizations and ED visits 48 months following their baseline hospitalization.

Home telemonitoring study for Japanese patients with heart failure (HOMES-HF): protocol for a multicentre randomised controlled trial

IntroductionDespite the encouraging results from several randomised controlled trials (RCTs) and meta-analyses, the ability of home telemonitoring for heart failure (HF) to improve patient outcomes remains controversial as a consequence...