Original Article

Efficacy of Multidisciplinary Outpatient Management (MOM) Program in Long Term Heart Failure Care

Authors: Rahul Jain, MD, Ariana Evenson, MSIV, Rohit Jain, MD, Elizabeth Biddison, MSIII, Darshan Dalal, MD, MPH, Kathleen M. Kelly, CRNP, Arezo J. Karmand, MSIII, Heide Hullsiek, MSIII, Jyothi Punnam, MD, Stephen Plantholt, MD

Abstract

Background: Heart failure (HF) management programs worldwide have reported conflicting outcomes in the past.


Objectives: We sought to determine retrospectively whether the multidisciplinary outpatient management (MOM) program [heart failure clinic (HFC)], decreased readmission rates (RR), duration of hospital stay, and/or mortality in HF patients.


Methods: Records of 138 HF patients who had their first encounter either as admission for HF at St. Agnes Hospital or visit to HFC during the period June 2005 through June 2006 were evaluated for outcomes through September 2007. Twenty-seven patients were followed in the HFC and 111 were in the non-HFC group. During follow up, 39 of the non-HFC group patients crossed over to the HFC group. All baseline parameters, except age (P = 0.006), were similar in both groups.


Results: In the HFC group 4 patients had a total of 5 readmissions, whereas 85 patients had a total of 187 readmissions (P < 0.001) in the non-HFC group. Average lengths of hospitalization were 5.2 ± 4.8 days and 4.2 ± 3.2 days (P = 0.18) and the number of readmissions/patient/year was 0.3 and 1.45 (P < 0.001) in the HFC and non-HFC groups, respectively. In the subgroup analysis of cross overs (n = 39), there was a 60% reduction in the readmission rate after crossing over to the HFC group. The significance of decreased mortality in the HFC group could not be assessed due to the small sample size.


Conclusion: The study suggests that the MOM program can significantly reduce RR secondary to HF.


Key Points


* There was a significantly higher readmission rate for heart failure exacerbation in patients not attending the clinic compared to those who did attend the clinic.


* There was no difference in the length of hospitalization in the two groups.


* This study was done in a community hospital and signifies the role of a structured heart failure clinic beyond pharmacological treatment in heart failure management.

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