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
Recommended Citation
Smith, Carol A.; Piamjariyakul, Ubolrat; Wick, Jo A.; Spertus, John A.; Russell, Christy; Dalton, Kathleen M.; Elyachar, Andrea; Vacek, James L.; Reeder, Katherine M.; Nazir, Niaman; and Ellerbeck, Edward F., "Multidisciplinary Group Clinic Appointments: The Self-Management and Care of Heart Failure (SMAC-HF) Trial" (2014). College of Nursing Faculty Publications. 6.
https://openprairie.sdstate.edu/con_pubs/6
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.