Abstract 2709: A Prospective Randomized Controlled Trial Comparing the Efficacy of a Standardized, Supraregionally Transferable Program for Monitoring and Education of Patients with Systolic Heart Failure with Usual Care - The Interdisciplinary Network for Heart Failure (INH) Study
Background: Disease management (DM) has not consistently improved outcome in chronic heart failure (CHF). Public funding for DM is not available in most health care systems, mainly because general transferability of successful programs has not been convincingly shown.
To develop and document in writing a multidisciplinary DM and
to assess its efficacy compared with ’care as usual’ (UC, care by GP + 6 monthly visits to CHF clinic) after 6 (n = 700) and 18 months (n = 1000). Here, we report the 6 months results.
Methods & Results: Between 04/04 and 08/06, 708 patients hospitalized for symptomatic systolic CHF (LV ejection fraction </= 40%) where recruited prospectively and randomized to either UC (n = 360) or DM (n = 348). The DM consists of telephone-based monitoring and modular education delivered by trained nurses. It includes educational material/self-monitoring schemes and multidisciplinary advice (if required) for patients and 6 monthly visits to a CHF clinic. Efficacy was measured by all cause mortality, time-to-first-event (all cause death, hospitalization), days alive and out of hospital, NYHA class, and quality of life (SF-36). Patient age was 68+/-12 yrs, 29% were female, and 40% were in NYHA class III–IV. Within 180 days 14% (n = 51) of the UC patients died vs. 8% (n = 28) in HNC (p = 0.018, HR = 0.6, 95% CI: 0.4–0.9). 34% (n = 122) and 33% (n = 113) died or were rehospitalised in UC and HNC, respectively (HR = 1.0, 95% CI: 0.8–1.3, P = 0.89). Compared with UC, the mean number of days alive out of hospital gained in HNC was -1 after 2, 0 after 3 and +4 after 6 months in HNC. HNC patients also improved more in NYHA class (-0.21 vs. -0.36, p = 0.029) and SF-36 age- and sex-adjusted physical functioning (+1.7 vs. + 5.9, p = 0.036) and physical health component (+1.2 vs. +2.9, p = 0.030).
Conclusion: The Interdisciplinary Network for Heart Failure (INH) Study indicates that the new DM substantially improves outcome at 6 months in patients hospitalized for systolic CHF. Mortality is reduced by 40% while morbidity is improved regarding clinical CHF severity and quality of life. As all components of this DM have been documented in detail supraregional transferability is possible, thus providing the basis for future more generalized use.