Abstract 11472: Higher Level of Chronic Illness Management in Heart Transplant Centers is associated With Better Patient Survival: The Intercontinental BRIGHT Study
Innovation in care processes based on chronic illness management (CIM) has shown to improve outcomes in chronically ill. We hypothesized that higher level of CIM in post-heart transplant (HTx) follow-up care is associated with better patient survival.
The BRIGHT study, a multi-center, cross sectional study included a convenience sample of 36 HTx centers in 11 countries and 4 continents. Patients were selected by stratified random sampling. CIM was assessed both by clinicians’ report (N=82, mean age: 47.6±10.2 y., 85% f.) (55 item CIMI BRIGHT instrument) and patients’ report (N=1026, mean age: 54.0±13.2 y., 27% f., mean years post-HTx; 3.4±1.4)(11 item PACIC scale). CIM data were aggregated at center level. Three groups were built: (1) positive deviants: both patients’ and clinicians’ median CIM scores above median CIM score of 36 centers;(2) negative deviants: both median CIM scores below median of all centers; (3) mixed group: incongruence in median CIM scores between patients and clinicians. Center's mean patient survival at 1, 3, 5, 10 and 15 years was reported by the HTx center director using a structured questionnaire. We used mixed regression analysis, contrasting positive to negative deviants in a confounder-adjusted analysis.
We found major variability in CIM scores (PACIC mean 39±10.5; CIMI BRIGHT mean 165±17.1, range: 136-197) and mean survival rates (1 year: 84%±5.3 ; 5 year 73%±15.8) among HTx centers. Thirty-two percent of centers were positive deviants, 32% negative deviants and 36% belonged to the mixed group. Figure 1 shows center's mean patient survival at 1, 3, 5, 10 and 15 years for the 3 groups. As hypothesized, mortality was lower in positive vs. negative deviants especially at 1 year post-HTx (p<0.008).
The association between higher levels of CIM and lower mortality in HTx patients highlights a potential pathway for improving outcomes after HTx by investing in innovative systems of care based on principles of CIM.
Author Disclosures: S.M. De Geest: None. K. Denhaerynck: None. L. Berben: None. J. Vanhaecke: None. C. Russell: None. F. Dobbels: None.
- © 2015 by American Heart Association, Inc.