European Heart Journal Advance Access originally published online on November 18, 2005
European Heart Journal 2006 27(5):596-612; doi:10.1093/eurheartj/ehi656
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Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes
1The Nethersole School of Nursing, The Chinese University of Hong Kong, Room 729, Esther Lee Building, Shatin, New Territories, Hong Kong
2The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
Received 23 July 2005; revised 20 September 2005; accepted 27 October 2005; online publish-ahead-of-print 18 November 2005.
* Corresponding author: Tel: +852 3163 4289; fax: +852 2603 5269. E-mail address: dyu{at}cuhk.edu.hk
Aims Disease management programmes (DMPs) have evolved as an innovative clinical practice system to enhance the discharge outcomes of older people with heart failure. Yet, clinical trials which have examined their effectiveness have reported inconsistent findings. This may be explained by variations in the design of DMPs. The aim is to identify the characteristics of DMPs which are crucial to reducing hospital readmission and/or mortality of older people with heart failure.
Methods and results A systematic computerized search was conducted to identify randomized controlled trials of the last 10 years, which examined the effects of DMPs on hospital readmission and mortality of older people with heart failure. The identified DMPs were classified as effective and ineffective, according to statistically significant changes in discharge outcomes. Twenty-one trials were identified, 11 (52.4%) of which reported DMPs improving the discharge outcomes of older people with heart failure. The results indicate that an effective DMP should be multi-faceted and consists of an in-hospital phase of care, intensive patient education, self-care supportive strategy, optimization of medical regimen, and ongoing surveillance and management of clinical deterioration. Cardiac nurse and cardiologist should be actively involved and a flexible approach should be adopted to deliver the follow-up care.
Conclusion This study defines precisely the characteristics of the care team and the organization content and delivery method of the DMP which are crucial to enhance the discharge outcomes of older people with heart failure.
Key Words: Heart failure • Disease management • Quality improvement • Hospital readmission • Elderly people
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