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Clinical Investigations: CARDIOLOGY |

Improving Care for Patients With Chronic Heart Failure in the Community*: The Importance of a Disease Management Program

Kwame O. Akosah, MD; Ana M. Schaper, PhD; Paul Havlik, MS; Sharon Barnhart, RN; Stephen Devine, MD
Author and Funding Information

*From the Gundersen Lutheran Medical Foundation, La Crosse, WI.

Correspondence to: Kwame O. Akosah, MD, Gundersen Lutheran Medical Foundation, 1836 South Ave, La Crosse, WI 54601; e-mail: kakosah@gundluth.org



Chest. 2002;122(3):906-912. doi:10.1378/chest.122.3.906
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Study objective: Utilizing a comparison group of patients with congestive heart failure (CHF) discharged to their primary care physicians, we sought to determine if disease management in a short-term, aggressive-intervention heart failure clinic (HFC) following hospital discharge is associated with improved outcomes.

Design: Chart review.

Setting: An integrated health-care center serving a tristate area.

Patients: Inclusion criteria were discharge from the hospital with a primary diagnosis of CHF, outpatient follow-up within the hospital system, and the presence of left ventricular systolic dysfunction as the basis for CHF. Patients were categorized into group 1 if they were referred to the HFC after hospital discharge, and into group 2 if follow-up care was provided by their primary care physician.

Measurements and results: There were 38 patients in group 1 and 63 patients in group 2. There was a trend toward a shorter time to the first outpatient visit following discharge (11 days vs 15 days, p = 0.09), more outpatient visits within 90 days (10 visits vs 2 visits, p < 0.001), and more patient-initiated contacts (four contacts vs one contact, p = < 0.001) in group 1 compared to group 2, respectively. The combined hospital readmission and mortality rate at 90 days (10% vs 30%, p < 0.018) and 1 year (21% vs 43%, p < 0.02) was lower in group 1. There was a 77% relative risk reduction for 30-day hospital readmission in favor of group 1, and a statistically lower rate of readmissions at 90 days and 1 year. Utilization and maintenance of standardized CHF medications were significantly higher in patients who attended the HFC.

Conclusions: A comprehensive disease management program for patients discharged with a diagnosis of CHF resulted in fewer rehospitalizations and improved event-free survival compared to patients followed up by their primary care physicians.

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