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Effect of multidisciplinary disease management for hospitalized heart failure under a national health insurance programme

Mao, Chun-Tai; Liu, Min-Hui; Hsu, Kuang-Hung; Fu, Tieh-Cheng; Wang, Jong-Shyan; Huang, Yu-Yen; Yang, Ning-I; Wang, Chao-Hung

Journal of Cardiovascular Medicine: September 2015 - Volume 16 - Issue 9 - p 616–624
doi: 10.2459/JCM.0000000000000089
Original articles: Heart failure
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Aim Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be effective in Western countries. However, it is not known whether they improve outcomes in a high population density country with a national health insurance programme.

Methods In total, 349 patients hospitalized because of heart failure were randomized into control and MDP groups. All-cause death and re-hospitalization related to heart failure were analyzed. The median follow-up period was approximately 2 years.

Results Mean patient age was 60 years; 31% were women; and 50% of patients had coronary artery disease. MDP was associated with fewer all-cause deaths [hazard ratio (HR) = 0.49, 95% confidence interval (CI) = 0.27–0.91, P = 0.02] and heart failure-related re-hospitalizations (HR = 0.44, 95% CI = 0.25–0.77, P = 0.004). MDP was still associated with better outcomes for all-cause death (HR = 0.53, 95% CI = 0.29–0.98, P = 0.04) and heart failure-related re-hospitalization (HR = 0.46, 95% CI = 0.26–0.81, P = 0.007), after adjusting for age, diuretics, diabetes mellitus, chronic kidney disease, hypertension, sodium, and albumin. However, MDPs’ effect on all-cause mortality and heart failure-related re-hospitalization was significantly attenuated after adjusting for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or β-blockers. A stratified analysis showed that MDP combined with guideline-based medication had synergistic effects.

Conclusions MDP is effective in lowering all-cause mortality and re-hospitalization rates related to heart failure under a national health insurance programme. MDP synergistically improves the effectiveness of guidelines-based medications for heart failure.

aDepartment of Internal Medicine, Division of Cardiology, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan

bDepartment of Nursing, National Yang-Ming University, Taipei, Taiwan

cDepartment of Healthcare Management, Laboratory for Epidemiology, Chang Gung University College

dHealthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan

Correspondence to Chao-Hung Wang, MD, PhD, Department of Internal Medicine, Division of Cardiology, Heart Failure Research Center, Chang Gung Memorial Hospital, 222 Mai Chin Road, 204 Keelung, Taiwan Tel: +886 2 24313131, ext. 2245; fax: +886 2 24314906; e-mail: bearty54@gmail.com

Received 10 August, 2013

Revised 26 February, 2014

Accepted 26 February, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.