Skip to main content
Log in

Disease Management of Chronic Heart Failure in the Elderly

Issues and Options

  • Current Opinion
  • Published:
Disease Management & Health Outcomes

Abstract

There is now conclusive evidence to support the widely prescribed application of disease management programs in heart failure care. These strategies result in significant improvement in many barometers of care, including admission rates, prescription of disease modifying therapy, and improved patient understanding and involvement in self care. Of particular importance in the future will be research designed to address the personnel requirements of disease management programs, the ideal format of the program, and how best to fit the program to a particular patient’s needs. It is also likely that further development of these programs will result in the application of disease management programs to a wider group of the heart failure population, not simply focusing on patients with relatively severe disease, but also addressing and involving patients from the time of diagnosis, and possibly even targeting those at risk for the development of heart failure. It is by this more inclusive approach that the concept will work towards the accepted definition of a disease management program, which should include attention to the entire spectrum of the disease, and involve all aspects of the healthcare delivery system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lloyd-Jones DM, Larson MG, Leip MS, et al. Lifetime risk for developing congestive heart failure: The Framingham Heart Study. Circulation 2002 Dec 10; 106(24): 3068–72

    Article  PubMed  Google Scholar 

  2. Kannel WB. Incidence and epidemiology of heart failure. Heart Fail Rev 2000; 5: 167–73

    Article  PubMed  CAS  Google Scholar 

  3. Stewart S, Jenkins A, Buchan S, et al. The current cost of heart failure to the NHS in the UK. Eur J Heart Fail 2002; 4: 361–71

    Article  PubMed  Google Scholar 

  4. Kannel WB, Ho KKL, Thom T. Changing epidemiological features of cardiac failure. Br Heart J 1995; 72: S3–9

    Article  Google Scholar 

  5. Philbin EF, Rocco Jr TA, Lindemuth NW, et al. Clinical outcomes in heart failure: report from a community based registry. Am J Med 1999; 107: 549–55

    Article  PubMed  CAS  Google Scholar 

  6. Pulignano G, Del Sindaco D, Tavazzi L, et al. Clinical features and outcomes of elderly outpatients with heart failure followed up in hospital cardiology units: data from a large nationwide cardiology database (IN-CHF Registry). Am Heart J 2002; 143: 45–55

    Article  PubMed  Google Scholar 

  7. Cleland JGF, Swedburg K, Follath F, et al. The EuroHeart Failure Survey Programme: survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003; 24: 422–63

    Google Scholar 

  8. Krumholz HM, Parent ME, Tu N, et al. Readmission after hospitalisation for congestive heart failure among Medicare beneficiaries. Arch Intern Med 1997; 157: 99–104

    Article  PubMed  CAS  Google Scholar 

  9. Hobbs FD, Kenkre JE, Roalfe AK, et al. Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. Eur Heart J 2002; 23: 1867–76

    Article  PubMed  CAS  Google Scholar 

  10. Juenger J, Schellberg D, Kraemer S, et al. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart 2002; 87: 235–41

    Article  PubMed  CAS  Google Scholar 

  11. Rich MW. Heart failure disease management: a critical review. J Card Fail 1999; 5: 64–75

    Article  PubMed  CAS  Google Scholar 

  12. McAlister FA, Lawson FME, Teo KK, et al. A systematic review of randomised trials of disease management programs in heart failure. Am J Med 2001; 110: 378–84

    Article  PubMed  CAS  Google Scholar 

  13. Whellan DJ, Hasselblad V, Peterson E, et al. Metaanalysis and review of heart failure disease management randomised controlled clinical trials. Am Heart J 2005; 149: 722–9

    Article  PubMed  Google Scholar 

  14. Elrodt G, Cook DJ, Lee J, et al. Evidence-based disease management. JAMA 1997; 278: 1687–92

    Article  Google Scholar 

  15. Fox KF, Cowie MR, Wood DA, et al. A rapid access heart failure clinic provides a prompt diagnostic and management of new heart failure presenting in the community. Eur J Heart Fail 2000; 2: 423–9

    Article  PubMed  CAS  Google Scholar 

  16. Horan M, Barrett F, Mulqueen M, et al. Basics of heart failure management: are they being ignored? Eur J Heart Fail 2000; 2: 101–5

    Article  PubMed  CAS  Google Scholar 

  17. Gonseth J, Guallar-Castillon P, Banegas JR, et al. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta analysis of published reports. Eur Heart J 2004 Sep; 25(18): 1570–95

    Article  PubMed  Google Scholar 

  18. Rich MW, Vinson JM, Sperry JC, et al. Prevention of readmission in elderly patients with congestive heart failure: results of a prospective, randomised pilot study. J Gen Intern Med 1993; 8: 585–90

    Article  PubMed  CAS  Google Scholar 

  19. McDonald K, Ledwidge M, Cahill J, et al. Heart failure management: multidisciplinary care has intrinsic benefits above the optimisation of medical care. J Card Fail 2002; 8: 142–8

    Article  PubMed  Google Scholar 

  20. Stewart S, Horowitz JD. Home-based intervention in congestive heart failure: long term implications on readmission and survival. Circulation 2002; 105: 2861–6

    Article  PubMed  Google Scholar 

  21. Blue L, Lang E, McMurray JJ, et al. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ 2001; 323: 715–8

    Article  PubMed  CAS  Google Scholar 

  22. Capomolla S, Febo O, Ceresa M, et al. Cost/utility in chronic heart failure: comparison between heart failure management program delivered by dayhospital and usual care. J Am Coll Cardiol 2002; 40: 1259–66

    Article  PubMed  Google Scholar 

  23. Ledwidge M, Ryan E, O’Loughlin C, et al. Heart failure care in a hospital unit: a comparison of standard 3-month and extended 6-month programs. Eur J Heart Fail 2005; 7: 385–91

    Article  PubMed  Google Scholar 

  24. Strömberg A, Mårtensson J, Fridlund B, et al. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure. Eur Heart J 2003; 24(11): 1014–23

    Article  PubMed  Google Scholar 

  25. Ledwidge M, Barry M, Cahill J, et al. Is multidisciplinary care of heart failure costbeneficial when combined with optimal medical care. Eur J Heart Fail 2003; 5: 381–9

    Article  PubMed  Google Scholar 

  26. Ledwidge M, Travers B, Ryder M, et al. Specialist care of heart failure improves appropriate pharmacotherapy at the expense of greater polypharmacy and drug interactions. Eur J Heart Fail 2004; 6: 235–43

    Article  PubMed  CAS  Google Scholar 

  27. Rich MW. Heart failure in older adults. Med Clin North Am 2006; 90: 863–85

    Article  PubMed  Google Scholar 

  28. Ekman I, Andersson B, Ehnfors M, et al. Feasibility of a nurse monitor outreach care program for elderly patients with moderate to severe heart failure. Eur Heart J 1998; 19: 1254–60

    Article  PubMed  CAS  Google Scholar 

  29. Cleland JF, Coletta AP, Clark AL. Clinical trials update from the American College Cardiology 2007: ALPHA, EVEREST, FUSION II, VALIDD, PARR-2, REMODEL, SPICE, COURAGE, COACH, REMADHE, pro-BNP for evaluation of dyspnoea and THIS-diet. Eur J Heart Fail 2007; 9: 740–5

    Article  PubMed  Google Scholar 

  30. Bruqqink-Andre dela Porte PW, Lok DJ, van Wijngaarden J, et al. Heart failure programmes in countries with a primary care based health care system: are additional trials necessary? Design of the DEAL-HF study. Eur J Heart Fail 2005; 7: 910–20

    Article  Google Scholar 

  31. Cleland JGF, Louis AA, Rigby AS, et al. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death. J Am Coll Cardiol 2005; 45: 1654–64

    Article  PubMed  Google Scholar 

  32. Reis SE, Holubkov R, Edmundowicz D, et al. Treatment of patients admitted to the hospital with congestive heart failure: speciality-related disparities in practice patterns and outcomes. J Am Coll Cardiol 1997; 30: 733–8

    Article  PubMed  CAS  Google Scholar 

  33. Bello D, Shah NB, Edep ME, et al. Self-reported differences between cardiologists and heart failure specialists in the management of chronic heart failure. Am Heart J 1999; 138: 100–7

    Article  PubMed  CAS  Google Scholar 

  34. Jaarsma T. Health professionals in the heart failure team. Eur J Heart Fail 2005; 7: 343–9

    Article  PubMed  Google Scholar 

  35. McDonald KM, Conlon C, Ledwidge M. Disease management programs for heart failure: not just for the ’sick’ heart failure population. Eur J Heart Fail 2007; 9: 113–7

    Article  PubMed  Google Scholar 

  36. Ojeda S, Acquita M, Delgado M, et al. Short and long term results of a programme for the prevention of readmissions and mortality in patients with heart failure: are effects maintained after stopping the program? Eur J Heart Fail 2005; 7: 921–6

    Article  PubMed  Google Scholar 

  37. Nguyen V, Ducharme A, White M, et al. Lack of long term benefits of a 6-month heart failure disease management program. J Card Fail 2007; 13: 287–93

    Article  PubMed  Google Scholar 

  38. Sulaiman HM, O’Loughlin C, Conlon C, et al. A review of the actual need and evolution of need for device therapy in a community heart failure population. Eur Heart J Suppl 2007 Sep; 28(1): 1–250

    Google Scholar 

  39. Mockler M, O’Loughlin C, Conlon C, et al. Discontinuation of heart failure medical therapy in a disease management programme predicts poorer outcome and increased cost. Eur J Heart Fail 2007; 6 (1 Suppl.): 121–2

    Google Scholar 

  40. Konstam M, Kronenberg MW, Rousseau MF, et al. Effects of the angiotensin converting enzyme inhibitor enalapril on the long term progression of left ventricular dilatation in patients with asymtpomatic systolic dysfunction: SOLVD (Studies of Left Ventricular Dysfunction) investigators. Circulation 1993; 88: 2277–83

    Article  PubMed  CAS  Google Scholar 

  41. Logeart D, Thabut G, Jourdain P, et al. Pre-discharge B-type natriuretic peptide assay for identifying patients at high risk of readmission after decompensated heart failure. J Am Coll Cardiol 2004; 43: 634–40

    Article  Google Scholar 

  42. Krumholz HM, Chin YT, Wang Y, et al. Predictors of readmission among elderly survivors of admission with heart failure. Am Heart J 2000; 139(1): 72–7

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this article. The author has no conflicts of interest that are directly relevant to the content of this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ken McDonald.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McDonald, K. Disease Management of Chronic Heart Failure in the Elderly. Dis-Manage-Health-Outcomes 15, 333–339 (2007). https://doi.org/10.2165/00115677-200715060-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200715060-00002

Keywords

Navigation