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(Circulation. 2002;105:2810.)
© 2002 American Heart Association, Inc.

Editorial

Improving Outcomes in Heart Failure

It’s Not Unusual Beyond Usual Care

Debra K. Moser, DNSc, RN; Douglas L. Mann, MD

From Cardiovascular Nursing, College of Nursing, University of Kentucky, Lexington; and Winters Center for Heart Failure Research, Baylor College of Medicine, and the Houston VAMC, Houston, Tex.

Correspondence to Debra K. Moser, DNSc, RN, Professor and Gill Chair of Cardiovascular Nursing, University of Kentucky, College of Nursing, 527 CON/HSLC Building, 760 Rose Ave, Lexington, KY 40536-0232. E-mail dmoser@uky.edu

Key Words: Editorials • heart failure • mortality

Heart failure is approaching epidemic proportions worldwide and is associated with substantial public and personal burden.^1–3 The public burden of heart failure is evident in the enormous costs of caring for patients with heart failure.⁴ Indeed, heart failure is the largest single Medicare expenditure and is the leading cause of hospitalization for those >65 years of age in many industrialized countries, including the United States. The majority of these healthcare costs can be attributed to hospitalizations for exacerbation of congestive heart failure.⁴ The 6-month readmission rate for congestive heart failure is close to 50%.^5–6 The personal burden of heart failure includes debilitating symptoms, frequent rehospitalizations, and high rates of mortality. Five years after receiving a diagnosis of heart failure, <40% of men or women are still alive.^7–8 Thus, the report in this issue of Circulation by Stewart and colleagues⁹ that patients randomized to a home-based heart failure disease management intervention instead of usual care had 36% fewer rehospitalizations and a 28% reduction in risk of death from all causes is of more than casual interest to patients, healthcare providers, and the institutions that provide health care for these patients. Before we discuss the significance and potential impact of the findings by Stewart et al,⁹ however, it will be useful to digress and briefly review the existing literature about the types of heart failure disease management programs that have proved useful thus far.

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Strategies for Improving Outcomes in Heart Failure

The traditional model of care delivery, "usual care," is thought to contribute to frequent hospitalizations . . . [Full Text of this Article]

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