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Influence of risk on reduction of readmission and death by disease management programs in heart failure

Citation

Huynh, QL and Whitmore, K and Negishi, K and Marwick, TH, on behalf of the ETHELRED Investigators, Influence of risk on reduction of readmission and death by disease management programs in heart failure, Journal of Cardiac Failure, 25, (5) pp. 330-339. ISSN 1071-9164 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 Elsevier Inc.

DOI: doi:10.1016/j.cardfail.2019.01.015

Abstract

Objective: Disease management programs (DMPs) may reduce short-term readmission or death after heart failure (HF) hospitalization. We sought to determine if targeting of DMP to the highest-risk patients could improve efficiency.

Methods and Results: Patients (n = 412) admitted with HF were randomized to usual care or an intensive DMP including optimizing intravascular volume status at discharge, increased self-care education, exercise guidance, closer home surveillance, and increased intensity of HF nurse follow-up. Both treatment groups were similar in demographics, medication use, Charlson comorbidity index, ejection fraction, and left ventricular and atrial volumes. Readmission or death occurred in 74/197 (37%) usual care and 50/215 (23%) DMP patients within 30 days (relative risk [RR] 0.62, 95% confidence interval [CI] 0.46-0.84), and 113/197 (57%) usual care and 78/215 (36%) DMP patients within 90 days, (RR 0.63, 9%% CI 0.51-0.78). The predicted risk of death and readmission (estimated from our previously developed risk score) was similar between treatment groups (mean predicted risk 38.6 22.2% vs 39.4 21.9%; P = .73) and similar across categories of predicted risk between the treatment groups. For 30-day readmission or death, patients from the 2 highest risk quintiles showed a benefit from intervention, and there was an interaction between intervention and predicted risk (P = .02). For 90-day readmission or death, most patients-other than those in the lowest-risk quintile-benefited from the intervention.

Conclusions: Use of a risk score may permit targeting of DMP to reduce HF admission. Intensive DMP may reduce short-term readmission or death, particularly in high-risk patients.

Item Details

Item Type:Refereed Article
Keywords:heart failure, intervention, mortality, readmission, risk score
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Whitmore, K (Mrs Kristyn Whitmore)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
ID Code:132998
Year Published:2019
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-05-30
Last Modified:2019-06-06
Downloads:0

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