Comprehensive multidisciplinary programs for the management of patients with congestive heart failure
To evaluate the impact of comprehensive, multidisciplinary management programs on the process of care, resource utilization, health care costs, and clinical outcomes in patients with congestive heart failure.
Measurements and main results
A MEDLINE search identified seven english-language reports that compared the process of care, clinical outcomes, or economic variables related to implementation of a multidisciplinary congestive heart failure management program of at least 3 month’s duration to a control or reference group. The primary intent of the programs was to emphasize compliance with recommended therapeutic principles, enhance patient education, and provide careful patient surveillance. Five of the studies reported improved functional status, aerobic capacity, or patient satisfaction. Six of the studies reported a 50% to 85% reduction in the risk of hospital admission. Three studies reported economic analyses with suggestive but not compelling evidence of financial benefit.
Comprehensive, multidisciplinary management programs for congestive heart failure can improve functional status and reduce the risk of hsspital admission, and they may lower medical costs.
Key wordscongestive heart failure disease management health care costs health services research quality improvement
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- 1.Captopril Multicenter Research Group. A placebo-controlled trial of refractory chronic congestive heart failure. J Am Coll Cardiol. 1983;2:755–63.Google Scholar
- 4.The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study. N Engl J Med. 1987;316:1429–35.Google Scholar
- 5.The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.Google Scholar
- 11.Konstam MA, Dracup K, Bottoroff MB. et al. Quick Reference Guide For Clinicians, No. 11: Heart Failure: Management of Patients with Left Ventricular Systolic Dysfunction. Rockville, Md: Agency for Health Care Policy and Research, Public Health Service, United States Department of Health and Human Services: 1994. AHCPR publication 94-0613.Google Scholar
- 17.Costanzo MR, Augustine S, Bourge R. et al. Selection and treatment of candidates for heart transplantation: a statement for health professionals from the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology. American Heart Association. Circulation. 1995;92:3593–612.PubMedGoogle Scholar
- 18.Killip T, Passamani E, Davis K. Coronary Artery Surgery Study (CASS): a randomized trial of coronary bypass surgery: eight years follow-up and survival in patients with reduced ejection fraction. Circulation. 1985;72(suppl V):V-102–9.Google Scholar
- 19.Smith W, McAnulty JH, Rahimtoola SH. Severe aortic stenosis with impaired left ventricular function and clinical heart failure: results of valve replacement. Circulation. 1978;58:258–64.Google Scholar
- 21.Domanski MJ, Garg R, Yusuf S. Prognosis in congestive heart failure. In: Hosenpud JD, Greenberg BH, eds. Congestive Heart Failure: Pathophysiology, Diagnosis and Comprehensive Approach to Management. New York, NY: Springer-Verlag; 1994:622–7.Google Scholar
- 23.Cardiology Preeminence Roundtable. Beyond Four Walls. Cost-Effective Management of Chronic Congestive Heart Failure. Washington, DC: The Advisory Board Company: 1994:39–47.Google Scholar
- 42.Philbin EF, Weil HF, Erb T. Outcomes in heart failure based on specialty care. Circulation. 1996;94[8 suppl 1]: 1–50. Abstract.Google Scholar
- 43.Shah N, Edep M, Massie BM. Differences between cardiologists and heart failure specialists in the management of congestive heart failure. Circulation. 1995;92[suppl 1]: 1–666. Abstract.Google Scholar