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A Multidisciplinary Disease Management Program Offers Sustained Improvement in Heart Failure-Specific Quality of Life

      Introduction

      HF is a progressive disease characterized by frequent decompensations and reduced quality of life (QoL).

      Hypothesis

      We hypothesized that a multidisciplinary HF disease management program (DMP) including cardiologists, nurses, and pharmacist could improve and sustain HF pt QoL over a long duration (1 year) of follow-up.

      Methods

      Consecutive pts admitted to a large Veterans Administration hospital from 10/2008 to 9/2011 with acute HF were screened and offered outpatient care via a HF DMP after discharge. QoL questionnaires (Kansas City Cardiomyopathy Questionnaire or KCCQ-higher score better; and Minnesota Living With Heart Failure Questionnaire or MLWHF-lower score better) were given to every HF pt at each outpatient clinic visit. Baseline QoL was assessed at the first clinic visit (<14 days post discharge), then QoL was reassessed at 1, 3, 6, and 12 months. Although QoL forms were given to pts to complete at each clinic visit, not all pts completed the assessment or may not have finished the entire assessment.

      Results

      We attempted QoL assessments on 730 pts and 706 pts completed at least one assessment. Of these, 98% were male, 81% Caucasian, mean age 74 years, mean EF 36%, mean BMI 31, mean Cr 1.5 mg/dl, and median NT-proBNP level 3318 pg/ml; 91% were NYHA class II or III at time of first clinic visit. Baseline KCCQ overall summary (OS) and MLWHF scores were 47.9 and 53.6, respectively. At baseline and 30 days, 330 pts completed the KCCQ while 309 pts completed a MLWHF questionnaire at both time points. The KCCQ OS and MLWHF scores improved significantly from baseline to 30 days (46.8 vs 50.3, p=0.002; 55.0 vs 50.3; p<0.001, respectively). QoL remained significantly improved at 3 and 6 months and was numerically improved at 1 year with a very strong trend for significance of MLWHF score (p=0.051).

      Conclusion

      Table 1. Abstract 124:Changes in QoL Compared to Baseline
      Mean Baseline QoL Score (std dev)Mean QoL Score at 30 days (std dev)Mean QoL Score at 3 months (std dev)Mean QoL Score at 6 months (std dev)Mean QoL Score at 1 Year (std dev)Mean Change from Baseline (95% CI)P Value
      KCCQ OS (N=320)46.8 (24.9)50.3 (25.3)3.54 (1.36,5.71)0.002
      KCCQ OS (N=336)48.2 (24.6)53.9 (24.9)5.69 (3.5,7.88)<0.001
      KCCQ OS (N=248)48.6 (24.9)52.6 (24.9)3.9 (1.35,6.53)0.003
      KCCQ OS (N=155)48.3 (24.9)50.1 (25.7)1.74 (-2.22,5.69).39
      MLWHF (N=309)55.0 (25.4)50.3 (25.6)-4.75 (-2.34,-7.17)<0.001
      MLWHF (N=317)54.2 (24.8)46.3 (25.4)-7.81 (-5.36,-10.27)<0.001
      MLWHF (N=240)53.7 (25.0)48.0 (27.0)-5.64 (-2.7,-8.58)<0.001
      MLWHF (N=149)53.1 (25.3)49.2 (26.3)-3.91 (.021,-7.830.051
      (N=149)7.83