A multicenter disease management program for hospitalized patients with heart failure

J Card Fail. 2004 Dec;10(6):473-80. doi: 10.1016/j.cardfail.2004.02.005.


Background: Despite the availability of proven therapies, outcomes in patients with heart failure (HF) remain poor. In this 2-stage, multicenter trial, we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF.

Methods and results: In Stage 1, a pharmacist or nurse assessed each patient and made recommendations to the physician to add or adjust angiotensin-converting enzyme (ACE) inhibitors and other HF medications. Before discharge (Stage 2), patients were randomized to a patient support program (PSP) (education about HF, self-monitoring, adherence aids, newsletters, telephone hotline, and follow-up at 2 weeks, then monthly for 6 months after discharge) or usual care. In Stage 1 (766 patients) ACE inhibitor use increased from 58% on admission to 83% at discharge (P < .0001), and the daily dose (in enalapril equivalents) increased from 11.3 +/- 8.8 mg to 14.5 +/- 8.8 mg (P < .0001). In Stage 2 (276 patients) there was no difference in ACE inhibitor adherence, but a reduction in cardiovascular-related emergency room visits (49 versus 20, P = .030), hospitalization days (812 versus 341, P = .003), and cost of care (2,531 Canadian dollars less per patient) in favor of the PSP.

Conclusion: Simple interventions can improve ACE inhibitor use and patient outcomes.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Canada
  • Counseling*
  • Disease Management*
  • Female
  • Heart Failure / drug therapy*
  • Heart Failure / therapy
  • Hospitalization* / economics
  • Humans
  • Inpatients / education
  • Inpatients / psychology
  • Male
  • Middle Aged
  • Patient Care Team
  • Patient Compliance
  • Patient Education as Topic


  • Angiotensin-Converting Enzyme Inhibitors