Clinical InvestigationA multicenter disease management program for hospitalized patients with heart failure☆
Section snippets
Study design and patient eligibility
REACT was a multicenter 2-stage trial consisting of an in-hospital intervention in all patients (Stage 1), followed by a randomized trial of a patient support program (Stage 2). Ten hospitals participated in REACT (Appendix A). Before study commencement, the local research coordinators (a hospital pharmacist or nurse) attended a training workshop to review current HF management guidelines8., 9. and study procedures to ensure consistency in the delivery of the patient support program among
Results
Recruitment took place between September 1999 and April 2000. A total of 766 patients were entered into Stage 1 (Fig. 2). The baseline characteristics of the patients entered into Stage 1 are indicated in Table 2. These patients represent a typical hospitalized patient population with HF with 55% males and an average age of 74. The majority of patients were in New York Heart Association functional class II and III and the majority of patients had an ischemic etiology of their HF. Eighty percent
Discussion
As a highly prevalent condition with high mortality and morbidity,1., 2., 3., 5., 6., 7. even small increments in the improvement of the care of patients with HF may have large public health implications. The results of this study indicate that a dedicated HF program using hospital pharmacists and nurses can result in an improvement in ACE inhibitor usage and dosing, with reductions in clinical events and costs.
Conclusion
A simple and practical in-hospital HF disease management program improved the utilization of ACE inhibitors by almost 50% and also promoted the usage of higher doses of ACE inhibitors. A 6-month patient education and support program for outpatients with HF had little impact on ACE inhibitor adherence however reduced utilization of health care resources, resulting in a cost reduction of $CDN 2531 per patient for CV-related events. Given the high prevalence and poor outcomes in this patient
Acknowledgements
We thank Marilou Hervas-Malo, MSc, Epidemiology Coordinating and Research (EPICORE) Centre, Division of Cardiology, University of Alberta, Edmonton, Alberta, for conducting some of the statistical analyses.
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Dr Johnson is a Population Health Investigator with Alberta Heritage Foundation for Medical Research and holds a Canada Research Chair in Diabetes Health Outcomes.
Funded by an unrestricted educational grant from Parke Davis Canada (now Pfizer Canada) and the University of Alberta Hospital Foundation.