Prospective evaluation of an outpatient heart failure disease management program designed for primary care: the Oregon model

Abstract

Background: Most heart failure care is provided by primary care providers. Although heart failure disease management programs improve outcomes, most have been hospital-based with little integration with primary care providers. To address this issue, a heart failure clinic disease management model was adapted for use in the primary care setting.

Methods and results: A heart failure clinic staffed by 2 internists and their nurses was established in a large primary care practice. Medical care and pharmacotherapy were based on national guidelines. Nurses assisted with disease management. Primary outcomes included quality of life, functional class, and all-cause hospital and emergency room admissions 12 months before compared with 12 months after enrollment; a secondary endpoint was patient satisfaction. Of 165 patients sent to the heart failure clinic, 54 were referred back because of no active heart failure, and 18 had only 1 clinic visit. The 93 patients seen 2 or more times had a median age of 75 years. Anti-angiotensin II therapy was present in 84% and did not change over time, but doses of angiotensin-converting enzyme inhibitor increased by >50%. beta-blocker use increased from 40% at baseline to 63% at 6 months. Emergency room visits or all-cause hospitalizations were reduced (0.86 +/- 1.5 to 0.52 +/- 0.86, P < .001) or trended to be reduced (0.56 +/- 0.98 to 0.35 +/- 0.62, P = .07), respectively, by approximately 40%. Quality of life improved significantly at all time points, and patients were highly satisfied.

Conclusion: This heart failure disease management model, designed for patients and providers in an primary care setting, was feasible and successful.