The Israel Medical Association journal : IMAJ · 2011
Clinical outcome of patients with chronic heart failure followed in a specialized heart failure center.
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Gotsman Israel, Zwas Donna, Zemora Zehava, Jabara Refat, Admon Dan, Lotan Chaim, Keren Andre
Аннотация
BACKGROUND: Patients with heart failure (HF) have a poor prognosis. Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis.
OBJECTIVES: To evaluate the clinical outcome of patients with HF treated at a multidisciplinary HF center of Clalit Health Services in Jerusalem in collaboration with Hadassah University Hospital.
METHODS: We evaluated clinical outcome including hospitalizations and death in all HF patients followed at the HF center for 1 year.
RESULTS: Altogether, 324 patients were included and followed at the HF center; 58% were males with a mean age of 76 +/- 11 years, and 58% were in New York Heart Association (NYHA) functional class Ill-IV. The overall 1 year survival rate was 91% and the 1 year hospitalization rate 29%. Comparing patients in the HF center to the whole cohort of patients with a diagnosis of HF (N = 6618) in Clalit Health Services in Jerusalem demonstrated a similar 1 year survival rate: 91% vs. 89% respectively but with a significantly reduced hospitalization rate: 29% vs. 42% respectively (P < 0.01). Cox regression analysis demonstrated that treatment in the HF center was a significant predictor of reduced hospitalization after adjustment for other predictors (hazard ratio 0.65, 95% confidence interval 0.53-0.80, P < 0.0001). A subset of patients that was evaluated (N = 78) showed significantly increased compliance. NYHA class improved in these patients from a mean of 3.1 +/- 0.1 to 2.6 +/- 0.1 after treatment (P < 0.0001).
CONCLUSIONS: Supervision by dedicated specialized nurses in a HF center increased compliance, improved functional capacity in HF patients, and reduced hospitalization rate. HF centers should be considered part of the standard treatment of patients with symptomatic HF.
OBJECTIVES: To evaluate the clinical outcome of patients with HF treated at a multidisciplinary HF center of Clalit Health Services in Jerusalem in collaboration with Hadassah University Hospital.
METHODS: We evaluated clinical outcome including hospitalizations and death in all HF patients followed at the HF center for 1 year.
RESULTS: Altogether, 324 patients were included and followed at the HF center; 58% were males with a mean age of 76 +/- 11 years, and 58% were in New York Heart Association (NYHA) functional class Ill-IV. The overall 1 year survival rate was 91% and the 1 year hospitalization rate 29%. Comparing patients in the HF center to the whole cohort of patients with a diagnosis of HF (N = 6618) in Clalit Health Services in Jerusalem demonstrated a similar 1 year survival rate: 91% vs. 89% respectively but with a significantly reduced hospitalization rate: 29% vs. 42% respectively (P < 0.01). Cox regression analysis demonstrated that treatment in the HF center was a significant predictor of reduced hospitalization after adjustment for other predictors (hazard ratio 0.65, 95% confidence interval 0.53-0.80, P < 0.0001). A subset of patients that was evaluated (N = 78) showed significantly increased compliance. NYHA class improved in these patients from a mean of 3.1 +/- 0.1 to 2.6 +/- 0.1 after treatment (P < 0.0001).
CONCLUSIONS: Supervision by dedicated specialized nurses in a HF center increased compliance, improved functional capacity in HF patients, and reduced hospitalization rate. HF centers should be considered part of the standard treatment of patients with symptomatic HF.