Over the past decade, health care experts have created and promoted "disease management" (DM) approaches to chronic diseases. DM programs use structured guidelines based on evidence of the benefits of various treatment approaches in improving outcomes for the people treated. Two new studies have validated improvements in care and outcomes in patients with congestive heart failure and coronary heart disease (CHD) who are taking part in a DM program.

Cardiologists at Duke University Medical Center created the Duke Heart Failure Program following a review of published therapies and management strategies. After ten months, researchers determined that medication use had improved and hospitalization was reduced among the 117 patients with congestive heart failure enrolled in the program. In fact, no patients were hospitalized during this period, compared to the center’s previous rate of 1.5 hospitalizations per patient-year. Clinic visits more than doubled, from 4.3 to 9.8 per patient-year. Further, the investigators calculated that the program saved the Duke University Health System a median of $8,571 per patient-year.

Across the Atlantic, British researchers evaluated the findings of 12 clinical trials of disease management programs for 9,803 patients with CHD. They found that DM programs had a positive impact on the processes of care. For example, patients in such programs were more likely to receive appropriate medications such as lipid-lowering drugs, beta-blockers, and antiplatelet agents. Five out of seven trials evaluating risk factor profiles showed significantly greater improvements with DM programs than with usual care in terms of mortality, recurrent heart attacks, and hospital admission. Most of the trials reported that quality of life or functional status was better for patients in DM programs.

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Sources:

• Whellan DJ, Gaulden L, Gattis WA, et al. The benefit of implementing a heart failure disease management program. Archives of Internal Medicine, Oct. 8, 2001;161(18):2223-2228. (Abs.)
• McAlister FA, Lawson FME, Teo KK, et al. Randomized trials of secondary prevention programs in coronary heart disease: systematic review. British Medical Journal, Oct. 27, 2001;323:957-962. (Abs.)