Study: Disease management gave heart failure patients more time

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Freeman

San Antonio (Nov. 16, 2004) – Patients with congestive heart failure who received disease management services – such as home visits and telephone calls from registered nurses – between trips to the doctor’s office lived longer than patients who did not receive the services, reported Gregory Freeman, M.D., and Autumn Dawn Galbreath, M.D., at the American Heart Association Scientific Meetings Nov. 7 in New Orleans. Drs. Freeman and Galbreath are faculty members at The University of Texas Health Science Center at San Antonio.

“We found that congestive heart failure disease management improved mortality of patients but did not save money,” Dr. Galbreath said. “This is very different from previous literature on the topic, and I predict it will have a big impact on policy.”

Medicare alone pays $3.6 billion per year for congestive heart failure.

Disease management involves closer monitoring of patients by professionals including registered nurses, and it is accomplished through home visits, telephone calls and educational materials sent by mail. The study group enrolled 1,069 patients with congestive heart failure; 710 received varying levels of disease management and 359 in the control group did not.

The patients in the disease management group lived an average two-and-a-half months longer during the study follow-up period. However, costs of hospitalizations, procedures and overall care were not reduced in the intervention group, as was previously theorized.

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Galbreath

“It shows you have to spend dollars to get better care,” Dr. Galbreath said.

The trial focused on publicly funded plan beneficiaries such as Medicare, VA and military beneficiaries, and unfunded patients. The patients came from the southern half of Texas.

“This is one of the first studies that had no industry funding and had a true control group for comparison,” Dr. Galbreath said. “That makes our data more scientifically rigorous and more objective.”

The study was conducted under a contract with the U.S. Department of Defense (DOD). U.S. Rep. Henry Bonilla worked with his colleagues on the Defense Appropriations Subcommittee to make sure the funding was included in the 2000 defense appropriations bill.

At the time of the study’s announcement in May 2000, it was predicted that the DOD award would have a direct impact on the 4.5 million Americans who suffer from congestive heart failure because it sought to improve management of day-to-day variations in symptoms.

Congestive heart failure results from impairment of the heart’s ability to pump oxygenated blood through the body. Patients accepted to the study had ejection fractions less than 49 percent (a normal, healthy value is 60 percent). The ejection fraction, which is determined by an echocardiogram (a sonogram of the heart), is a measurement of the amount of blood pumped by the heart during each beat.

Weight gain, a signal of fluid retention, is one of the signs of congestive heart failure progression. Patients in the disease management arm of the trial received bathroom scales to help nurses keep tighter surveillance on changes in their weight.

The Health Science Center partnered on the study with Brooke Army Medical Center, Wilford Hall Medical Center, the South Texas Veterans Health Care System (STVHCS), TRICARE Region 6, the University Health System and private physicians in South Texas.

Dr. Freeman was principal investigator for the study. He is professor and chief of the division of cardiology in the department of medicine at the Health Science Center and staff physician with the STVHCS.

Dr. Galbreath is vice chair for clinical programs in the department of medicine and staff physician with the STVHCS, and she served as director of the Health Science Center’s UT Disease Management Center for several years of the project. At the time of her promotion to vice chair, she was succeeded in that capacity by Monica Lee, M.D., instructor of cardiology.



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