The prevalence of congestive heart failure (CHF) increases progressively with advancing age, and CHF is a major cause of mortality, morbidity, and diminished quality of life in the elderly. Not only is CHF the most common cardiovascular indication for hospitalization in patients 65 years or older, but repetitive hospitalizations are frequent, occurring in 30-50% of patients within 3-6 months of initial discharge, and creating an imposing cost burden in caring for these patients. To address this problem, a pilot study was conducted at this institution, in which it was shown that elderly CHF patients at risk for early readmission can be identified at the time of initial hospitalization, that up to 50% of readmissions are potentially preventable, and that a nonpharmacologic treatment strategy consisting of patient education, medication analysis, discharge planning, and enhanced follow-up is feasible and may reduce readmissions by 30-35%. Based on these findings, the specific aims of the present research are to conduct a randomized controlled trial assessing the impact of a multidisciplinary treatment program on 3-month readmission-free survival in elderly CHF patients; to evaluate possible mechanisms for any demonstrated improvement in outcome; to evaluate the effect of the study intervention on quality of life and the cost of care; and to develop a treatment manual to facilitate implementation of the program at other institutions. Over a 4-year period, 320 patients 70 years or older hospitalized with documented CHF and at increased risk for early readmission will be randomly assigned to receive the study intervention or standard care. The study intervention consists of individualized patient education utilizing teaching materials specifically designed for this study; a careful review of medications with specific recommendations designed to eliminate unnecessary drugs, decrease the number of dosing intervals, improve compliance, and minimize side effects; early discharge planning; and enhanced post-discharge follow-up. I The primary study endpoint is 3-month readmission-free survival. Principal secondary endpoints include analyses of the effect of the study intervention on compliance with prescribed medications, dietary sodium intake, incidence of adverse drug reactions, patient knowledge and understanding of CHF, patient-assessed quality of life, and the overall cost of medical care. The findings of this study are likely to have major implications for the care of elderly CHF patients, as well as patients with other illnesses.
| Rich, M W; Stitziel, N O; Kovacs, S J (1999) Prognostic value of diastolic filling parameters derived using a novel image processing technique in patients > or = 70 years of age with congestive heart failure. Am J Cardiol 84:82-6 |
| Pernenkil, R; Vinson, J M; Shah, A S et al. (1997) Course and prognosis in patients > or = 70 years of age with congestive heart failure and normal versus abnormal left ventricular ejection fraction. Am J Cardiol 79:216-9 |
| Rich, M W; Gray, D B; Beckham, V et al. (1996) Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. Am J Med 101:270-6 |
| Rich, M W; Beckham, V; Wittenberg, C et al. (1995) A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333:1190-5 |
