Effect of multidisciplinary disease management for hospitalized heart failure under a national health insurance programme. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Mao, Chun-Tai; Liu, Min-Hui; Hsu, Kuang-Hung; Fu, Tieh-Cheng; Wang, Jong-Shyan; Huang, Yu-Yen; Yang, Ning-I; Wang, Chao-Hung
• Is Part Of: Journal of cardiovascular medicine. Volume 16:Issue 9(2015:Sep.)
• Publication Date: 2015-09
• Subjects: Cardiology -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; 616.1005
• DOI: 10.2459/JCM.0000000000000089
• Languages: English
• ISSNs: 1558-2027

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Aim</title> <p>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.</p> </sec> <sec> <title>Methods</title> <p>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.</p> </sec> <sec> <title>Results</title> <p>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, <italic>P</italic> = 0.02] and heart failure-related re-hospitalizations (HR = 0.44, 95% CI = 0.25–0.77, <italic>P</italic> = 0.004). MDP was still associated with better outcomes for all-cause death (HR = 0.53, 95% CI = 0.29–0.98, <italic>P</italic> = 0.04) and heart failure-related re-hospitalization (HR = 0.46, 95% CI = 0.26–0.81, <italic>P</italic> = 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.</p> </sec> <sec> <title>Conclusions</title> <p>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.</p> </sec> </abstract>