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document
Long-term prospective , randomized , controlled study using repetitive education at six-month intervals and monitoring for adherence in heart failure outpatients : the REMADHE trial . BACKGROUND The effectiveness of heart failure disease management programs in patients under cardiologists ' care over long-term follow-up is not established . METHODS AND RESULTS We investigated the effects of a disease management program with repetitive education and telephone monitoring on primary ( combined death or unplanned first hospitalization and quality-of-life changes ) and secondary end points ( hospitalization , death , and adherence ) . The REMADHE [ Repetitive Education and Monitoring for ADherence for Heart Failure ] trial is a long-term randomized , prospective , parallel trial designed to compare intervention with control . One hundred seventeen patients were randomized to usual care , and 233 to additional intervention . The mean follow-up was 2.47+/-1.75 years , with 54 % adherence to the program . In the intervention group , the primary end point composite of death or unplanned hospitalization was reduced ( hazard ratio , 0.64 ; confidence interval , 0.43 to 0.88 ; P=0.008 ) , driven by reduction in hospitalization . The quality-of-life questionnaire score improved only in the intervention group ( P < 0.003 ) . Mortality was similar in both groups . Number of hospitalizations ( 1.3+/-1.7 versus 0.8+/-1.3 , P < 0.0001 ) , total hospital days during the follow-up ( 19.9+/-51 versus 11.1+/-24 days , P < 0.0001 ) , and the need for emergency visits ( 4.5+/-10.6 versus 1.6+/-2.4 , P < 0.0001 ) were lower in the intervention group . Beneficial effects were homogeneous for sex , race , diabetes and no diabetes , age , functional class , and etiology . CONCLUSIONS For a longer follow-up period than in previous studies , this heart failure disease management program model of patients under the supervision of a cardiologist is associated with a reduction in unplanned hospitalization , a reduction of total hospital days , and a reduced need for emergency care , as well as improved quality of life , despite modest program adherence over time .
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Intervention_Educational
disease management program with repetitive education and telephone monitoring
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Intervention_Educational
Education and Monitoring
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Intervention_Control
control
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Outcome_Mortality
death
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Outcome_Other
unplanned first hospitalization
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Outcome_Other
quality-of-life changes
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Outcome_Other
hospitalization
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Outcome_Mortality
death
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Outcome_Mental
adherence
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Outcome_Mortality
composite of death
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Outcome_Other
unplanned hospitalization
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Outcome_Other
hospitalization .
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Outcome_Other
quality-of-life questionnaire score
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Outcome_Mortality
Mortality
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Outcome_Other
Number of hospitalizations
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Outcome_Other
total hospital days during the follow-up
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Outcome_Other
need for emergency visits
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Outcome_Other
unplanned hospitalization
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Outcome_Other
total hospital days
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Outcome_Other
need for emergency care
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Outcome_Other
improved quality of life
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Outcome_Other
program adherence
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Participant_Condition
heart failure outpatients
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Participant_Sample-size
One hundred seventeen
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Participant_Sample-size
233