Mortality benefit of a comprehensive heart failure disease management program in indigent patients

Kathy A. Hebert, Ronald L. Horswell, Sydney E Dy, Ira J. Key, Michael K. Butler, Frederick P. Cerise, Lee M. Arcement

Research output: Contribution to journalArticle

Abstract

Background: Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is still a paucity of data on their effect on mortality. The objective of this study was to determine whether participation in an HFDM program would reduce mortality in an indigent population from rural Louisiana. Methods: Proportional hazards modeling was used to determine whether patients participating in the HFDM program had improved survival compared with patients receiving traditional outpatient care at the same institution. Inclusion criteria consisted of an index hospitalization with discharge occurring between July 1, 1997, and May 30, 2002, hospital discharge diagnosis of HF, left ventricular systolic dysfunction documented during hospitalization, and at least 1 subsequent outpatient visit. Data from patients having participated in the HFDM program before their index hospitalization were excluded. Results: Compared with patients who were given traditional care (n = 100), HFDM patients (n = 156) were younger (56.7 vs 60 years, P = .031), more likely to be African American (48.7% vs 33.0%, P = .014), more likely to be uninsured (47.4% vs 27%, P = .001), and more likely to have an ejection fraction of ≤25% (73.1% vs 36%, P <.001). Overall comorbidity did not differ significantly between the groups. After controlling for differences in demographics, ejection fraction, and comorbidities, participation in the HFDM program was associated with a significant reduction in mortality compared with traditional care (adjusted hazard ratio .33, P <.001). Conclusion: In this indigent population, participation in an HFDM program was associated with decreased mortality compared with traditional follow-up care.

Original languageEnglish (US)
Pages (from-to)478-483
Number of pages6
JournalAmerican Heart Journal
Volume151
Issue number2
DOIs
StatePublished - Feb 2006

Fingerprint

Poverty
Disease Management
Heart Diseases
Heart Failure
Mortality
Hospitalization
Comorbidity
Morbidity
Aftercare
Left Ventricular Dysfunction
Rural Population
Ambulatory Care
African Americans
Outpatients
Demography
Survival
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hebert, K. A., Horswell, R. L., Dy, S. E., Key, I. J., Butler, M. K., Cerise, F. P., & Arcement, L. M. (2006). Mortality benefit of a comprehensive heart failure disease management program in indigent patients. American Heart Journal, 151(2), 478-483. https://doi.org/10.1016/j.ahj.2005.04.022

Mortality benefit of a comprehensive heart failure disease management program in indigent patients. / Hebert, Kathy A.; Horswell, Ronald L.; Dy, Sydney E; Key, Ira J.; Butler, Michael K.; Cerise, Frederick P.; Arcement, Lee M.

In: American Heart Journal, Vol. 151, No. 2, 02.2006, p. 478-483.

Research output: Contribution to journalArticle

Hebert, KA, Horswell, RL, Dy, SE, Key, IJ, Butler, MK, Cerise, FP & Arcement, LM 2006, 'Mortality benefit of a comprehensive heart failure disease management program in indigent patients', American Heart Journal, vol. 151, no. 2, pp. 478-483. https://doi.org/10.1016/j.ahj.2005.04.022
Hebert, Kathy A. ; Horswell, Ronald L. ; Dy, Sydney E ; Key, Ira J. ; Butler, Michael K. ; Cerise, Frederick P. ; Arcement, Lee M. / Mortality benefit of a comprehensive heart failure disease management program in indigent patients. In: American Heart Journal. 2006 ; Vol. 151, No. 2. pp. 478-483.
@article{59960b4242954477bd43783a2d8fbbc9,
title = "Mortality benefit of a comprehensive heart failure disease management program in indigent patients",
abstract = "Background: Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is still a paucity of data on their effect on mortality. The objective of this study was to determine whether participation in an HFDM program would reduce mortality in an indigent population from rural Louisiana. Methods: Proportional hazards modeling was used to determine whether patients participating in the HFDM program had improved survival compared with patients receiving traditional outpatient care at the same institution. Inclusion criteria consisted of an index hospitalization with discharge occurring between July 1, 1997, and May 30, 2002, hospital discharge diagnosis of HF, left ventricular systolic dysfunction documented during hospitalization, and at least 1 subsequent outpatient visit. Data from patients having participated in the HFDM program before their index hospitalization were excluded. Results: Compared with patients who were given traditional care (n = 100), HFDM patients (n = 156) were younger (56.7 vs 60 years, P = .031), more likely to be African American (48.7{\%} vs 33.0{\%}, P = .014), more likely to be uninsured (47.4{\%} vs 27{\%}, P = .001), and more likely to have an ejection fraction of ≤25{\%} (73.1{\%} vs 36{\%}, P <.001). Overall comorbidity did not differ significantly between the groups. After controlling for differences in demographics, ejection fraction, and comorbidities, participation in the HFDM program was associated with a significant reduction in mortality compared with traditional care (adjusted hazard ratio .33, P <.001). Conclusion: In this indigent population, participation in an HFDM program was associated with decreased mortality compared with traditional follow-up care.",
author = "Hebert, {Kathy A.} and Horswell, {Ronald L.} and Dy, {Sydney E} and Key, {Ira J.} and Butler, {Michael K.} and Cerise, {Frederick P.} and Arcement, {Lee M.}",
year = "2006",
month = "2",
doi = "10.1016/j.ahj.2005.04.022",
language = "English (US)",
volume = "151",
pages = "478--483",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Mortality benefit of a comprehensive heart failure disease management program in indigent patients

AU - Hebert, Kathy A.

AU - Horswell, Ronald L.

AU - Dy, Sydney E

AU - Key, Ira J.

AU - Butler, Michael K.

AU - Cerise, Frederick P.

AU - Arcement, Lee M.

PY - 2006/2

Y1 - 2006/2

N2 - Background: Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is still a paucity of data on their effect on mortality. The objective of this study was to determine whether participation in an HFDM program would reduce mortality in an indigent population from rural Louisiana. Methods: Proportional hazards modeling was used to determine whether patients participating in the HFDM program had improved survival compared with patients receiving traditional outpatient care at the same institution. Inclusion criteria consisted of an index hospitalization with discharge occurring between July 1, 1997, and May 30, 2002, hospital discharge diagnosis of HF, left ventricular systolic dysfunction documented during hospitalization, and at least 1 subsequent outpatient visit. Data from patients having participated in the HFDM program before their index hospitalization were excluded. Results: Compared with patients who were given traditional care (n = 100), HFDM patients (n = 156) were younger (56.7 vs 60 years, P = .031), more likely to be African American (48.7% vs 33.0%, P = .014), more likely to be uninsured (47.4% vs 27%, P = .001), and more likely to have an ejection fraction of ≤25% (73.1% vs 36%, P <.001). Overall comorbidity did not differ significantly between the groups. After controlling for differences in demographics, ejection fraction, and comorbidities, participation in the HFDM program was associated with a significant reduction in mortality compared with traditional care (adjusted hazard ratio .33, P <.001). Conclusion: In this indigent population, participation in an HFDM program was associated with decreased mortality compared with traditional follow-up care.

AB - Background: Heart failure (HF) produces significant morbidity and mortality. Although HF disease management (HFDM) programs have been shown to decrease this morbidity, there is still a paucity of data on their effect on mortality. The objective of this study was to determine whether participation in an HFDM program would reduce mortality in an indigent population from rural Louisiana. Methods: Proportional hazards modeling was used to determine whether patients participating in the HFDM program had improved survival compared with patients receiving traditional outpatient care at the same institution. Inclusion criteria consisted of an index hospitalization with discharge occurring between July 1, 1997, and May 30, 2002, hospital discharge diagnosis of HF, left ventricular systolic dysfunction documented during hospitalization, and at least 1 subsequent outpatient visit. Data from patients having participated in the HFDM program before their index hospitalization were excluded. Results: Compared with patients who were given traditional care (n = 100), HFDM patients (n = 156) were younger (56.7 vs 60 years, P = .031), more likely to be African American (48.7% vs 33.0%, P = .014), more likely to be uninsured (47.4% vs 27%, P = .001), and more likely to have an ejection fraction of ≤25% (73.1% vs 36%, P <.001). Overall comorbidity did not differ significantly between the groups. After controlling for differences in demographics, ejection fraction, and comorbidities, participation in the HFDM program was associated with a significant reduction in mortality compared with traditional care (adjusted hazard ratio .33, P <.001). Conclusion: In this indigent population, participation in an HFDM program was associated with decreased mortality compared with traditional follow-up care.

UR - http://www.scopus.com/inward/record.url?scp=31344437039&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=31344437039&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2005.04.022

DO - 10.1016/j.ahj.2005.04.022

M3 - Article

C2 - 16442918

AN - SCOPUS:31344437039

VL - 151

SP - 478

EP - 483

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 2

ER -