Abstract 2719: A Higher Program Intensity/complexity Score Is Associated With Lower Morbidity And Mortality In Patients Participating In Heart Failure Programs
Background: The overall efficacy of heart failure management programs (CHF-MPs) has been demonstrated in several meta-analyses. However, these meta-analyses have not determined which specific interventions within a program result in beneficial patient outcomes.
Method: The aim was to develop a scoring method for interventions within a CHF-MP and to determine if the score reflected patient outcomes. All CHF-MPs in Australia (n=55) were surveyed to determine program characteristics and interventions. A total of 49 programs (89%) were then prospectively characterised according to the complexity of management using an investigator developed instrument. Six month morbidity and mortality rates in 617 consecutively recruited patients in NYHA Class II-IV were then examined according to the complexity of the program.
Results: A total of 27 interventions were identified using the survey. Variability in the use of the key interventions was common among the programs. Interventions implemented by all program co-ordinators were patient and carer education concerning disease, diet, medications, and exercise. Symptom monitoring, daily weighs, and fluid restriction were some more interventions undertaken by all coordinators. There were 12 interventions that were implemented in an ad-hoc manner by coordinators, including discharge planning and titration of medications such as diuretics. Each intervention was allocated a score of one and a total score was calculated for each program and converted to a scale of 100. Programs were then categorised into low or high complexity based upon the number of interventions implemented. A cut-point total score of ≥89 (median score, range: 63–96) was used. Programs with a high score (high number of interventions implemented within the program) had a 37% reduction in risk of hospital admission and/or death (HR 0.63, 95%CI 0.43– 0.94, p=0.02) compared to programs with a low score.
Conclusion: The more interventions a program coordinator implemented within their program the greater the reduction in subsequent hospital admissions and mortality. This is the first time that a scoring algorithm for programs has been developed and used to identify programs expected to result in better patient outcomes.