Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is a paucity of data of their effect on mortality, especially in indigent settings. The objective was to determine whether participation in a HFDM program would be associated with reduced mortality in an indigent population from rural Louisiana.
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 < 40% documented during hospitalization, and at least 1 subsequent outpatient visit. Data from patients having participated in the HFDM program prior to their index hospitalization were excluded. Patients were allocated to the different management strategies in a nonrandomized non-blinded fashion at the discretion of the discharging physician.
Compared with patients who were given traditional care (n = 100), HFDM patients (n = 156) were younger (56.7 vs 60 years; P = 0.031), 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 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, 0.33; P <.001). Median annual income for both groups was $ 11,300.
In this indigent population, participation in a HFDM program was associated with decreased mortality compared with traditional follow-up care.
Utilizing disease management in this deadly disease should be considered and ascertaining the impact of this exact disease management model in other heart failure populations should be undertaken.
Lee Arcement, None.