The proposed study will test the efficacy of a comprehensive case management system for heart failure. The proposed system establishes a management infrastructure that utilizes nurse case managers and computerized databases with backup from program cardiologists to monitor and provide individualized treatment to patients. The investigators suggest that an effective system of anticipatory care can reduce the rates of rehospitalization, morbidity, and mortality compared to the usual post-hoc care provided to most heart failure patients. The investigators believe that post-hoc management results from deficits in three areas of treatment practice, including cognitive deficits (i.e., not knowing what should be done), executive deficits (i.e., not doing what should be done), and organizational deficits (i.e., not seeing patients when they need to be seen and seeing patients when they do not need to be seen). The investigators believe that their comprehensive case management system (MULTIFIT) can reduce these deficits and improve the outcome of patient care. The MULTIFIT program was examined in a small sample of 51 patients over a 138-day period, and its use resulted in significant improvements in functional status. The preliminary data from this uncontrolled pilot study provide support for the hypothesis to be tested in the proposed project. This project will randomize 646 patients admitted with heart failure in two Kaiser Permanente Medical Centers to usual care alone or usual care plus the MULTIFIT case management system. The unit of randomization is the patient. Case management is carried out by specially trained nurse case managers who gather essential data about patients through telephone contact and monitor patients' medical status and progress and initiate treatment following management guidelines. A computerized database facilitates acquisition of data and generates progress reports for physicians. Back-up from program cardiologists is available for nurse-initiated consultation. Treatment and follow-up extends over 12 months.
