Survival Benefit but No Cost Savings Found in Disease Management of Heart Failure

November 7, 2004 (eshonline.org) – A statistically significant reduction in mortality (p=0.037) was found in patients randomized to the intervention group (disease management by telephone) compared to the control group, in this trial presented at the American Heart Association Scientific Sessions 2004. The survival benefit in patients in the intervention group compared to the control group was 76 days (mean survival 536.9 days vs 450.5 days). No statistically significant effect was seen on event-free survival. Although the intervention improved survival and improved NYHA functional class, the 6-minute walk-test or quality of life were not improved. Further, health care utilization and cost were not reduced.

In the Long-Term Healthcare and Cost Outcomes of Disease Management in a Large, Randomized Community-Based Population with Heart Failure, 1069 patients (age 70 years) with heart failure (EF 35%, or echo-confirmed diastolic heart failure) were randomized to the 18-month intervention (710 patients) or control (359 patients). The trial was simultaneously published in Circulation (www.circulationaha.org). A cost-efficacy analysis will be published in early 2005. The results of this study diverge from the disease management literature, which shows improvements in outcomes and cost savings. The investigators noted that disease management may be most useful when there is a marked disparity between optimal patient management and the actual management being provided. At baseline, the patients in the present trial were very well managed. In contrast to previous trials in which only about 30% to 50% of the patients were receiving an ACE inhibitor, in the present trial 77% were receiving ACE inhibitor therapy. Thus, it may be more difficult to prove the benefit of disease management.