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Impact of multi-disciplinary treatment strategy on systolic heart failure outcome

BACKGROUND: Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, heart failure disease management programs (HFDMPs) have proven effective for reducing readmissions for decompensated heart failure or other cardiovascu...

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Autores principales: Chen, Shyh-Ming, Fang, Yen-Nan, Wang, Lin-Yi, Wu, Ming-Kung, Wu, Po-Jui, Yang, Tsung-Hsun, Chen, Yung-Lung, Hang, Chi-Ling
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794772/
https://www.ncbi.nlm.nih.gov/pubmed/31615409
http://dx.doi.org/10.1186/s12872-019-1214-0
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author Chen, Shyh-Ming
Fang, Yen-Nan
Wang, Lin-Yi
Wu, Ming-Kung
Wu, Po-Jui
Yang, Tsung-Hsun
Chen, Yung-Lung
Hang, Chi-Ling
author_facet Chen, Shyh-Ming
Fang, Yen-Nan
Wang, Lin-Yi
Wu, Ming-Kung
Wu, Po-Jui
Yang, Tsung-Hsun
Chen, Yung-Lung
Hang, Chi-Ling
author_sort Chen, Shyh-Ming
collection PubMed
description BACKGROUND: Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, heart failure disease management programs (HFDMPs) have proven effective for reducing readmissions for decompensated heart failure or other cardiovascular causes by up to 30%. However, the benefits of HFDMP in different populations of heart failure patients is unknown. METHOD: This observational cohort study compared mortality and readmission in heart failure patients who participated in an HFDMP (HFDMP group) and heart failure patients who received standard care (non-HFDMP group) over a 1-year follow-up period after discharge (December 2014 retrospectively registered). The components of the intervention program included a patient education program delivered by the lead nurse of the HFDMP; a cardiac rehabilitation program provided by a physical therapist; consultation with a dietician, and consultation and assessment by a psychologist. The patients were followed up for at least 1 year after discharge or until death. Patient characteristics and clinical demographic data were compared between the two groups. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HRs) for death or recurrent events of hospitalization in the HFDMP group in comparison with the non-HFDMP group while controlling for covariates. RESULTS: The two groups did not significantly differ in demographic characteristics. The risk of readmission was lower in the HFDMP group, but the difference was not statistically significant (HR = 0.36, p = 0.09). In patients with ischemic cardiomyopathy, the risk of readmission was significantly lower in the HFDMP group compared to the non-HFDMP group (HR = 0.13, p = 0.026). The total mortality rate did not have significant difference between this two groups. CONCLUSION: The HFDMP may be beneficial for reducing recurrent events of heart failure hospitalization, especially in patients with ischemic cardiomyopathy. TRIAL REGISTRATION: Longitudinal case-control study ISRCTN98483065, 24/09/2019, retrospectively registered.
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spelling pubmed-67947722019-10-21 Impact of multi-disciplinary treatment strategy on systolic heart failure outcome Chen, Shyh-Ming Fang, Yen-Nan Wang, Lin-Yi Wu, Ming-Kung Wu, Po-Jui Yang, Tsung-Hsun Chen, Yung-Lung Hang, Chi-Ling BMC Cardiovasc Disord Research Article BACKGROUND: Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, heart failure disease management programs (HFDMPs) have proven effective for reducing readmissions for decompensated heart failure or other cardiovascular causes by up to 30%. However, the benefits of HFDMP in different populations of heart failure patients is unknown. METHOD: This observational cohort study compared mortality and readmission in heart failure patients who participated in an HFDMP (HFDMP group) and heart failure patients who received standard care (non-HFDMP group) over a 1-year follow-up period after discharge (December 2014 retrospectively registered). The components of the intervention program included a patient education program delivered by the lead nurse of the HFDMP; a cardiac rehabilitation program provided by a physical therapist; consultation with a dietician, and consultation and assessment by a psychologist. The patients were followed up for at least 1 year after discharge or until death. Patient characteristics and clinical demographic data were compared between the two groups. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HRs) for death or recurrent events of hospitalization in the HFDMP group in comparison with the non-HFDMP group while controlling for covariates. RESULTS: The two groups did not significantly differ in demographic characteristics. The risk of readmission was lower in the HFDMP group, but the difference was not statistically significant (HR = 0.36, p = 0.09). In patients with ischemic cardiomyopathy, the risk of readmission was significantly lower in the HFDMP group compared to the non-HFDMP group (HR = 0.13, p = 0.026). The total mortality rate did not have significant difference between this two groups. CONCLUSION: The HFDMP may be beneficial for reducing recurrent events of heart failure hospitalization, especially in patients with ischemic cardiomyopathy. TRIAL REGISTRATION: Longitudinal case-control study ISRCTN98483065, 24/09/2019, retrospectively registered. BioMed Central 2019-10-15 /pmc/articles/PMC6794772/ /pubmed/31615409 http://dx.doi.org/10.1186/s12872-019-1214-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chen, Shyh-Ming
Fang, Yen-Nan
Wang, Lin-Yi
Wu, Ming-Kung
Wu, Po-Jui
Yang, Tsung-Hsun
Chen, Yung-Lung
Hang, Chi-Ling
Impact of multi-disciplinary treatment strategy on systolic heart failure outcome
title Impact of multi-disciplinary treatment strategy on systolic heart failure outcome
title_full Impact of multi-disciplinary treatment strategy on systolic heart failure outcome
title_fullStr Impact of multi-disciplinary treatment strategy on systolic heart failure outcome
title_full_unstemmed Impact of multi-disciplinary treatment strategy on systolic heart failure outcome
title_short Impact of multi-disciplinary treatment strategy on systolic heart failure outcome
title_sort impact of multi-disciplinary treatment strategy on systolic heart failure outcome
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794772/
https://www.ncbi.nlm.nih.gov/pubmed/31615409
http://dx.doi.org/10.1186/s12872-019-1214-0
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