(Circulation. 1997;96:2842-2848.)
© 1997 American Heart Association, Inc.
Articles |
Effect of a Heart Failure Program on Hospitalization Frequency and Exercise Tolerance
From the Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tenn.
Correspondence to John R Wilson MD, Division of Cardiology, 315 MRB II, Vanderbilt University Medical Center, Nashville, TN 37232-6300.
Background Most patients with heart failure are currently managed by physicians with little specific expertise in heart failure. This management system has been associated with evidence of suboptimal care, such as high rates of hospital readmission and underuse of ACE inhibitors. The current study was undertaken to determine whether hospitalization rates and functional outcomes are improved when patients are managed by physicians with special expertise in heart failure working in a dedicated heart failure program.
Methods and Results All patients with heart failure
referred to the Vanderbilt Heart Failure and Heart Transplantation
Program between July 1994 and June 1995 were identified. Annual
hospitalization rates, medications, and peak exercise capacity before
and after referral were compared in patients followed for >30 days. A
total of 187 patients were referred during the index time period, of
whom 134 (72%) were followed for >30 days. During the year before
referral, 94% of the patients were hospitalized (210
cardiovascular hospitalizations) versus 44% of the
patients during the year after referral (104 hospitalizations) (53%
reduction) (P<.01). Hospitalizations for heart failure
decreased from 164 to 60 for all patients regardless of follow-up
duration and decreased from 97 to 30 (69% reduction) for patients
followed at least 1 year after referral. Eighty-eight of the patients
were able to exercise at the time of referral. Peak exercise
O2 in this group increased from
12.8±4.7 to 15.7±4.8 mL · min-1 · kg-1
(P<.01) by 6 months after referral. Loop diuretic
doses were on averaged doubled during the first 6 months after
referral.
Conclusions These findings suggest that patients with heart failure have fewer hospitalizations for heart failure and are significantly more functional when managed by heart failure specialists working in a dedicated heart failure program rather than by physicians with limited expertise in heart failure.
Key Words: heart failure • outcomes • exercise
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