Extrait

Background and study aims Heart failure (HF) occurs when the heart becomes unable to pump blood efficiently. Symptoms include difficulty with breathing and leg swelling. HF is the final result of several diseases more common in aging patients, such as high blood pressure, but it can also be the result of changes associated with age itself. Although new drug treatments have improved outcomes for heart failure patients, hospital readmission and death rates, particularly for hospitalized elderly patients, remain high. There is good evidence in patients with HF and high risk of hospitalization that multidisciplinary strategies based on coordination and continuity of care, disease management programs (DMPs), can reduce hospitalization and death rates, improve quality of life and lower overall medical costs. In these DMPs a case manager provides patients and their caregivers with sufficient information and support to develop and comply with a plan to control HF. However, most clinical trials in HF have excluded elderly patients with significant functional impairment, multiple illnesses and living in a nursing home. We aimed to assess the cost-effectiveness of a management program after hospital discharge in elderly patients with HF with any of these conditions. Who can participate? To take part you need to be aged over 65 and have been discharged home or to a nursing home without medical staff after a hospital stay due to HF of at least 48 hours. What does the study involve? Participants were randomly allocated to one of two groups. While one group received the DMP, consisting of a comprehensive hospital discharge planning and close follow-up at a geriatric day-hospital, the other group received the pre-existing routine of post-discharge care. After hospital discharge, the patients were managed in accordance with current clinical practice. In general, this meant that the patient was treated and followed by their primary care physician. Both groups received medical treatment in accordance with current clinical practice and were followed-up for 12 months. What are the possible benefits and risks of participating? All participants received medical treatment. The main goals of the HF treatment were to relieve symptoms, maintain or enhance functional capacity and quality of life, preserve independence, and extend survival. The goals of the DMP program were to reduce hospitalization and death rates, and improve quality of life and also lower overall medical costs. There were no known risks to participants. Where is the study run from? The study was conducted with patients of the Caceres Health Area after hospital discharge in a single center (Complejo Hospitalario de Cáceres) (Spain). When is the study starting and how long is it expected to run for? The study ran from March 2007 to November 2010. Who is funding the study? Regional Government of Extremadura (Spain) and European Union (FEDER). Who is the main contact? Dr José Luis González Guerrero [email protected]

Critère d'inclusion

• Heart failure in the elderly

Liens

• isrctn
• ictrp