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.
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.
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.
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: firstname.lastname@example.org
Received 10 August, 2013
Revised 26 February, 2014
Accepted 26 February, 2014