Document Type

Article

Publication Date

11-2014

Keywords

heart failure, group clinic, clinical trial, rehospitalization; survival analysis

Abstract

Background—This trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure (HF) rehospitalization or death.

Methods and Results—HF patients (n=198) were randomly assigned to standard care or standard care plus multidisciplinary group clinics. The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6, where multidisciplinary professionals engaged patients in HF self-management skills. Data were collected prospectively for 12 months beginning after completion of the first 4 group clinic appointments (2 months post randomization). The intervention was associated with greater adherence to recommended vasodilators (P=0.04). The primary outcome (first HF-related hospitalization or death) was experienced by 22 (24%) in the intervention group and 30 (28%) in standard care. The total HF-related hospitalizations, including repeat hospitalizations after the first time, were 28 in the intervention group and 45 among those receiving standard care. The effects of treatment on rehospitalization varied significantly over time. From 2 to 7 months post randomization, there was a significantly longer hospitalization-free time in the intervention group (Cox proportional hazard ratio=0.45 (95% confidence interval, 0.21–0.98; P=0.04). No significant difference between groups was found from month 8 to 12 (hazard ratio=1.7; 95% confidence interval, 0.7–4.1).

Conclusions—Multidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway. Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits.

Publication Title

Circulation: Heart Failure

Volume

7

Issue

6

First Page

888

Pages

17

Format

application/pdf

Language

en

DOI of Published Version

10.1161/CIRCHEARTFAILURE.113.001246

Publisher

American Heart Association

Rights

© 2014 American Heart Association

Comments

This is the accepted manuscript of an article published in final edited form in Circulation: Heart Failure, 7(6): 888-894 doi:10.1161/CIRCHEARTFAILURE.113.001246.

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