SUCCESS OF A MULTIDISCIPLINARY DISEASE MANAGEMENT PROGRAM IN LONG TERM SYSTOLIC HEART FAILURE CARE

Abstract

Objective. The aim of this study was to evaluate the use of a standardized protocol in a heart failure disease management program (HFDMP) to improve medical adherence, blood pressure control and vaccination rates among patients with systolic heart failure. Background. Heart failure (HF) is becoming a major public health problem with a 1-year mortality rate that ranges from 28% in the youngest patients with minimal co morbidities to 61% in the oldest population with high risk factors. In spite of new diagnostic and therapeutic tools, the prognosis for a new diagnosis of heart failure is still poor. In an effort to reduce the morbidity, mortality, and economic cost of HF, several organizations, including the American College of Cardiology and the European Society of Cardiology have developed evidence-based HF management guidelines. Methods. We conducted a cross sectional study that included 561 patients, (56% Hispanic, 4.5% non-Hispanic Caucasian and 39% non-Hispanic African American), who were enrolled from September 2007 to January 2009 into a HFDM at the Jackson Memorial Hospital (JMH), an urban 1600 bed safety-net hospital, in Miami, Florida. The inclusion criteria were age e 18 years with systolic heart failure defined as ejection fraction d 40% by echocardiography. Medical adherence, blood pressure control and immunization state were assessed at baseline and follow up visits. Results. At baseline 82% of Hispanics, 75% of White and 79% of Black patients were taking ACEI/ARB. The percentage of White and Black patients taking ACEI/ARB increased over the four visits. There was also a significant difference in comparing baseline to fourth visit in Hispanic patients for the total dose (p=0.002) and target dose (p \u3c 0.001) for beta blocker therapy. Patients enrolled in the HFDMPs with untrolled BP experienced a significant decrease in their BP levels and those whose BP was under control at baseline remained within JNC VII recommendations throughout the study. The baseline prevalence of vaccination against influenza and pneumococcal disease was 28.3% and 30.7% respectively. Within the mean follow up period of 2- 4.6 months between the first and second visit to the HFDMP, vaccination prevalence improved for both influenza (50.4%) and pneumococcal disease (65.5%) with the combined prevalence improving to 60.5%. Conclusion. Enrollment into the HFDMP was effective in improving medical adherence, in achieving better blood pressure control and in increasing immunization prevalence without creating disparities. Grants. N/