Heart Failure Disease Management Program and the Six Months Readmission Rate

Abstract

Background: HF is a chronic syndrome associated with frequent hospitalizations. It represents a considerable burden to the healthcare system with high rates of readmissions. Optimizing medical care through a special DMP may improve outcome and decrease readmission rates. Purpose: To assess the effect of heart failure (HF) disease management program (DMP) on the six months all cause readmission rate for patients with HF as compared to regular care. Methods: This is a prospective non-randomized clinical trial that was conducted during 2012 - 2013. Patients presenting with acute HF with EF <40% were recruited. We enrolled 151 patients of whom 71 were in DMP and 80 in the control group. Patients were enrolled in the control group when they elected to receive only regular care by their physicians. The DMP consists of 2 phases. Phase I started during the index hospitalization where education about HF symptoms, medications, diet and exercise was delivered. Phase II consisted of close outpatient follow-up after discharge. The first visit was at 7 days, then at 1 month and every 3 months for a total of 6 months. During follow-up augmentation of HF medications, education on disease management, diet and exercise were done. The primary outcome was all cause readmission rate at 6 months. The secondary outcome was all cause mortality at 6 months. Results: The two groups were comparable at baseline. The majority were males, with 58% had ischemic heart disease and 40% were diabetics. The average EF in both groups was 30%. Patients enrolled in the DMP had a shorter length of stay in days (9.5+/-7.1 DMP group vs. 12.7+/-10.5 control group), (P=0.03). However, the cost of each hospitalization was not significantly different (DMP: $3320.00+/-2785.00) vs. (control: $4218.00+/-$4519.00), (P=0.14). The primary outcome of all cause readmissions at 6 months was significantly lower in the DMP (28.2% DMP group vs. 57.5% control group) (P<0.001). The secondary outcome of all cause mortality tends to be lower at 6 months in the DMP vs. control (9.9% vs. 20.0% repectively) (P=0.08). A multivariate analysis for the predictors of the readmissions at 6 months was only significant for the DMP vs. the control group (Adjusted OR (95% CI); 0.26 (0.12-0.56); (P=0.001). The use of digoxin and dobutamine was associated with higher mortality (P=0.009). Conclusion: A HF DMP that entails close follow-up after discharge with education, diet and exercise will decrease all cause readmission rates at 6 months and tends to lower mortality when compared to regular care.