AIM: Specialized management of HF patients does not prevent deaths

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Neither moderate nor intensive disease management by a nurse specializing in management of patients with heart failure (HF) reduced the combined endpoints of death and hospitalization from HF compared with standard follow-up, according to a trial published in the Feb.11 issue of the Archives of Internal Medicine.

The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multi-center, randomized, controlled trial in which 1,023 patients were enrolled after hospitalization because of HF.

Dirk J. van Veldhuisen, MD, department of cardiology at the University Medical Center Groningen in the Netherlands assigned patients to one of three groups: a control group (follow-up by a cardiologist) and two intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. The patients were studied for 18 months.

The primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization, according to researchers.

The authors reported that the mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF.

During the study, they found 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively. The number of days lost to death or hospitalization was 39,960 in the control group, 33,731 days for the basic intervention group, and 34 268 for the intensive support group, according to the authors.

All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined, while there were slightly more hospitalizations in the two intervention groups, the researchers said.

The authors wrote that though the findings seem to contrast earlier similar studies, they should not lead to abandoning the concept of disease management programs for HF; rather, they must lead to more precise definitions of how such programs should be implemented.

“These data will contribute to the discussion of optimal design and execution of disease management in patients with HF and indicate that one model does not fit all patients or all healthcare systems,” the authors wrote.

Hospital admissions contribute substantially (60%-70%) to costs of treating patients with HF, and in the study, the threshold may have been too low to admit patients to the hospital. Organizing short hospitalizations effectively is one of the major challenges in the future, according to the researchers.

Veldhuisen and colleagues said they observed effect on mortality, not statistically significant, but promising because mortality is a pivotal clinical end point in patients with HF. The authors said that this suggests that nonpharmacologic intervention may have been successful in preventing progression of the disease.