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David J. Whellan, MD; Laura Gaulden, NP; Wendy A. Gattis, PharmD, BCPS; Bradi Granger, RN; Stuart D. Russell, MD; Michael A. Blazing, MD; Michael S. Cuffe, MD; Christopher M. O'Connor, MD

Arch Intern Med. 2001;161:2223-2228.

Background  To handle the increasing complexity of congestive heart failure (CHF) care, several new models for the care of patients with CHF have been developed to replace traditional strategies. We undertook this study to evaluate the potential benefit of implementing a CHF disease management program at a tertiary care center, particularly in terms of -blocker use and cost to the health care system.

Methods  After reviewing the literature regarding therapies and management strategies for patients with CHF, we developed the Duke Heart Failure Program. All enrolled patients had 1 of the following: recent CHF hospitalization, ejection fraction less than 20%, or symptoms consistent with New York Heart Association class III or IV. We compared preenrollment and postenrollment medication use and resource utilization.

Results  We enrolled 117 patients from July 1998 to April 1999. Mean enrollment time was 4.7 months. -Blocker use and dose significantly increased (52% vs 76% for -blocker, P<.01; 6% vs 13% of target dose, P<.01). The hospitalization rate decreased (1.5 vs 0 hospitalizations per patient-year, P<.01), while the number of clinic visits increased (4.3 vs 9.8 clinic visits per patient-year, P<.01). The Duke University Health System saved a median of $8571 per patient-year.

Conclusions  Implementing a CHF disease management program was associated with improved CHF medication dosing and with decreased hospitalization for patients with CHF. A CHF disease management program is an effective method for a health care system to care for patients with CHF.

From the Duke University Medical Center, Durham, NC.

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