Document Detail

Mortality benefit of a comprehensive heart failure disease management program in indigent patients.
MedLine Citation:
PMID:  16442918     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is still a paucity of data on their effect on mortality. The objective of this study was to determine whether participation in an HFDM program would reduce mortality in an indigent population from rural Louisiana. METHODS: Proportional hazards modeling was used to determine whether patients participating in the HFDM program had improved survival compared with patients receiving traditional outpatient care at the same institution. Inclusion criteria consisted of an index hospitalization with discharge occurring between July 1, 1997, and May 30, 2002, hospital discharge diagnosis of HF, left ventricular systolic dysfunction documented during hospitalization, and at least 1 subsequent outpatient visit. Data from patients having participated in the HFDM program before their index hospitalization were excluded. RESULTS: Compared with patients who were given traditional care (n = 100), HFDM patients (n = 156) were younger (56.7 vs 60 years, P = .031), more likely to be African American (48.7% vs 33.0%, P = .014), more likely to be uninsured (47.4% vs 27%, P = .001), and more likely to have an ejection fraction of < or = 25% (73.1% vs 36%, P < .001). Overall comorbidity did not differ significantly between the groups. After controlling for differences in demographics, ejection fraction, and comorbidities, participation in the HFDM program was associated with a significant reduction in mortality compared with traditional care (adjusted hazard ratio .33, P < .001). CONCLUSION: In this indigent population, participation in an HFDM program was associated with decreased mortality compared with traditional follow-up care.
Kathy A Hebert; Ronald L Horswell; Sydney Dy; Ira J Key; Michael K Butler; Frederick P Cerise; Lee M Arcement
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  151     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-30     Completed Date:  2006-02-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  478-83     Citation Subset:  AIM; IM    
Leonard J. Chabert Medical Center, Houma, LA, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Disease Management*
Heart Failure / drug therapy,  economics,  mortality*
Louisiana / epidemiology
Middle Aged
Odds Ratio
Poverty / statistics & numerical data*
Program Evaluation
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Ventricular Dysfunction, Left / drug therapy,  economics,  mortality*
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors

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