Prospective evaluation of an outpatient heart failure management program

Background: Although considerable effort has been devoted to the follow-up of hospitalized patients, the effectiveness and process of heart failure outpatient management have not been well demonstrated. Methods and Results: All new patients referred to the program from April 1997 to September 1998 were followed and managed by comprehensive strategies including preemptive hospitalization. Quality of life (QOL) and patients' self-care adherence behaviors were measured at baseline, 3 months, and 6 months. Clinical outcomes were compared for the 6 months before and 6 months after referral. A total of 108 patients were recruited. Patients' self-cart: knowledge score was improved over time (difference score = 0.9, P < .01). The proportion of patients weighing themselves daily increased by 24% (P = .02). The proportion of patients with New York Heart Association (NYHA) class III to IV was 67.6% at baseline and 49.1% at 6 months (P = .01). Compared with 6 months before referral, the program intervention was accompanied by a 52% reduction in the risk of hospitalization for cardiovascular causes (56.1% v 27.2%. P < .001) and a 72% reduction in emergency room visits (53.6% v 14.5%, P < .01). The total hospital admissions for cardiovascular causes decreased by 59% from 94 to 39; the total emergency room visits decreased by 77% from 83 to 19. The patients' QOL was improved over rime with a change score of 11.2 (P < .001) at 3 months and 10.7 (P < .001) at 6 months. Conclusion: Our study shows the effectiveness of this heart failure outpatient management program.