Heart failure disease management program experience in 4,545 heart failure admissions to a community hospital

Pazin-Filho, Antonio; Peitz, Pamela; Pianta, Thomas; Carson, Kathryn A.; Russell, Stuart D.; Boulware, Leigh Ebony; Coresh, Josef

doi:10.1016/j.ahj.2009.06.024

« Previous Next »American Heart Journal
Volume 158, Issue 3 , Pages 459-466, September 2009

Heart failure disease management program experience in 4,545 heart failure admissions to a community hospital

Antonio Pazin-Filho, MD, PhD
- Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil
- Reprint requests: Antonio Pazin-Filho, R. Bernardino de Campus, 1000, Ribeirão Preto, SP, Brazil, CEP, 14030-100.
Pamela Peitz, RN
- Washington County Hospital, Hagerstown, MD
Thomas Pianta, MPT
- Washington County Hospital, Hagerstown, MD
Kathryn A. Carson, ScM
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Stuart D. Russell, MD, PhD
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
Leigh Ebony Boulware, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Josef Coresh, MD, PhD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Received 19 January 2009; accepted 13 June 2009.

Background

Disease management programs (DMPs) are developed to address the high morbi-mortality and costs of congestive heart failure (CHF). Most studies have focused on intensive programs in academic centers. Washington County Hospital (WCH) in Hagerstown, MD, the primary reference to a semirural county, established a CHF DMP in 2001 with standardized documentation of screening and participation. Linkage to electronic records and state vital statistics enabled examination of the CHF population including individuals participating and those ineligible for the program.

Methods

All WCH inpatients with CHF International Classification of Diseases, Ninth Revision code in any position of the hospital list discharged alive.

Results

Of 4,545 consecutive CHF admissions, only 10% enrolled and of those only 52.2% made a call. Enrollment in the program was related to: age (OR 0.64 per decade older, 95% CI 0.58-0.70), CHF as the main reason for admission (OR 3.58, 95% CI 2.4-4.8), previous admission for CHF (OR 1.14, 95% CI 1.09-1.2), and shorter hospital stay (OR 0.94 per day longer, 95% CI 0.87-0.99). Among DMP participants mortality rates were lowest in the first month (80/1000 person-years) and increased subsequently. The opposite mortality trend occurred in nonenrolled groups with mortality in the first month of 814 per 1000 person-years in refusers and even higher in ineligible (1569/1000 person-years). This difference remained significant after adjustment. Re-admission rates were lower among participants who called consistently (adjusted incidence rate ratio 0.62, 95% CI 0.52-0.77).

Conclusion

Only a small and highly select group participated in a low-intensity DMP for CHF in a community-based hospital. Design of DMPs should incorporate these strong selective factors to maximize program impact.