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Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)

Tiny Jaarsma, PhD; Martje H. L. van der Wal, PhD; Ivonne Lesman-Leegte, MSc; Marie-Louise Luttik, PhD; Jochem Hogenhuis, PhD; Nic J. Veeger, MSc; Robbert Sanderman, PhD; Arno W. Hoes, MD; Wiek H. van Gilst, PhD; Dirk J. A. Lok, MD; Peter H. J. M. Dunselman, MD; Jan G. P. Tijssen, PhD; Hans L. Hillege, MD; Dirk J. van Veldhuisen, MD; for the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) Investigators

Arch Intern Med. 2008;168(3):316-324.

Background:  Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.

Methods  The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.

Results  Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P  = .81), and 34 268 for the intensive support group (P  = .49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P  = .89; and intensive support group, P  = .60).

Conclusions  Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups.

Clinical Trial Registry  http://trialregister.nl Identifier: NCT 98675639

Author Affiliations: Departments of Cardiology (Drs Jaarsma, van der Wal, Luttik, Hogenhuis, van Gilst, Hillege, and van Veldhuisen, Ms Lesman-Leegte, and Mr Veeger) and Psychology (Dr Sanderman), University Medical Center Groningen, University of Groningen, Groningen; Division Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Dr Hoes); Deventer Hospital, Deventer (Dr Lok); Amphia Hospital, Breda (Dr Dunselman); and Academic Medical Center Amsterdam, Amsterdam (Dr Tijssen), the Netherlands.

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