PMID- 11174340
OWN - NLM
STAT- MEDLINE
DCOM- 20010329
LR  - 20071115
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 141
IP  - 2
DP  - 2001 Feb
TI  - Heart failure disease management in an indigent population.
PG  - 254-8
AB  - BACKGROUND: Multidisciplinary disease management programs (MDMP) have 
      demonstrated reduced hospitalizations in motivated pretransplant heart failure 
      populations, but little is known about their effectiveness in largely indigent 
      patients who are not transplant candidates. METHODS AND RESULTS: We studied 35 
      patients with heart failure with left ventricular ejection fraction (EF) </=45% 
      enrolled in an MDMP who were either indigent or funded by Medicaid/Medicare. This 
      nonrandomized sample consisted of 14 patients identified because they had 
      hospital readmission rates of >/=2 per year (group A) and 21 patients referred by 
      their primary care physicians because they were difficult to manage (group B). 
      Group A patients were New York Heart Association (NYHA) class III or IV, aged 25 
      to 87 years (mean 57 +/- 17 SD) and had an EF of 15% to 45% (29% +/- 11%). Group 
      B patients were NYHA class II or III, aged 35 to 86 (57 +/- 16) years and had an 
      EF of 20% to 45% (28% +/- 10%). Data were compared for the year before enrollment 
      in the MDMP and the year afterward. In group A hospital admissions decreased from 
      33 to 3, a 91% reduction, and NYHA class improved to class II-III (P <.001). In 
      group B hospital admissions decreased from 9 to 0, and NYHA class improved to 
      class I-II (P <.001). When hospital and clinic charges were assessed for both 
      groups, the net savings were $162,000 per year or $4600 per patient. CONCLUSIONS: 
      A multidisciplinary heart failure program can improve functional status and 
      reduce hospitalization and net costs compared with conventional care in indigent 
      non-transplant candidate patients.
FAU - O'Connell, A M
AU  - O'Connell AM
AD  - University of New Mexico School of Medicine, Albuquerque, NM 87122, USA. 
      aoconne@itsa.icsf.edu
FAU - Crawford, M H
AU  - Crawford MH
FAU - Abrams, J
AU  - Abrams J
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Costs and Cost Analysis
MH  - Female
MH  - Heart Failure/*economics/therapy
MH  - Hospital Costs
MH  - *Hospitalization/economics/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Medical Indigency/economics
MH  - *Medically Uninsured/statistics & numerical data
MH  - Middle Aged
MH  - Retrospective Studies
MH  - United States
EDAT- 2001/02/15 11:00
MHDA- 2001/04/03 10:01
CRDT- 2001/02/15 11:00
PHST- 2001/02/15 11:00 [pubmed]
PHST- 2001/04/03 10:01 [medline]
PHST- 2001/02/15 11:00 [entrez]
AID - S0002-8703(01)20484-0 [pii]
AID - 10.1067/mhj.2001.111956 [doi]
PST - ppublish
SO  - Am Heart J. 2001 Feb;141(2):254-8. doi: 10.1067/mhj.2001.111956.