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Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: the SPAN-CHF trial.
Circulation. 2004 Sep 14; 110(11):1450-5.Circ

Abstract

BACKGROUND

Several trials support the usefulness of disease management (DM) for improving clinical outcomes in heart failure (HF). Most of these studies are limited by small sample size; absence of concurrent, randomized controls; limited follow-up; restriction to urban academic centers; and low baseline use of effective medications.

METHODS AND RESULTS

We performed a prospective, randomized assessment of the effectiveness of HF DM delivered for 90 days across a diverse provider network in a heterogeneous population of 200 patients with high baseline use of approved HF pharmacotherapy. During a 90-day follow-up, patients randomized to DM experienced fewer hospitalizations for HF [primary end point, 0.55+/-0.15 per patient-year alive versus 1.14+/-0.22 per patient-year alive in control subjects; relative risk (RR), 0.48, P=0.027]. Intervention patients experienced reductions in hospital days related to a primary diagnosis of HF (4.3+/-0.4 versus 7.8+/-0.6 days hospitalized per patient-year; RR, 0.54; P<0.001), cardiovascular hospitalizations (0.81+/-0.19 versus 1.43+/-0.24 per patient-year alive; RR, 0.57; P=0.043), and days in hospital per patient-year alive for cardiovascular cause (RR, 0.64; P<0.001). Intervention patients showed a trend toward reduced all-cause hospitalizations and total hospital days. On long-term (mean, 283 days) follow-up, there was substantial attrition of the 3-month gain in outcomes, with sustained significant reduction only in days in hospital for cardiac cause.

CONCLUSIONS

In a population with high background use of standard HF therapy, a DM intervention, uniformly delivered across varied clinical sites, produced significant short-term improvement in HF-related clinical outcomes. Longer-term benefit likely requires more active chronic intervention, even among patients who appear clinically stable.

Authors+Show Affiliations

Division of Cardiology, Tufts-New England Medical Center, and Tufts University School of Medicine, Boston, Mass 02111, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15313938

Citation

Kimmelstiel, Carey, et al. "Randomized, Controlled Evaluation of Short- and Long-term Benefits of Heart Failure Disease Management Within a Diverse Provider Network: the SPAN-CHF Trial." Circulation, vol. 110, no. 11, 2004, pp. 1450-5.
Kimmelstiel C, Levine D, Perry K, et al. Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: the SPAN-CHF trial. Circulation. 2004;110(11):1450-5.
Kimmelstiel, C., Levine, D., Perry, K., Patel, A. R., Sadaniantz, A., Gorham, N., Cunnie, M., Duggan, L., Cotter, L., Shea-Albright, P., Poppas, A., LaBresh, K., Forman, D., Brill, D., Rand, W., Gregory, D., Udelson, J. E., Lorell, B., Konstam, V., ... Konstam, M. A. (2004). Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: the SPAN-CHF trial. Circulation, 110(11), 1450-5.
Kimmelstiel C, et al. Randomized, Controlled Evaluation of Short- and Long-term Benefits of Heart Failure Disease Management Within a Diverse Provider Network: the SPAN-CHF Trial. Circulation. 2004 Sep 14;110(11):1450-5. PubMed PMID: 15313938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: the SPAN-CHF trial. AU - Kimmelstiel,Carey, AU - Levine,Daniel, AU - Perry,Kathleen, AU - Patel,Ayan R, AU - Sadaniantz,Ara, AU - Gorham,Noreen, AU - Cunnie,Margaret, AU - Duggan,Lynne, AU - Cotter,Linda, AU - Shea-Albright,Patricia, AU - Poppas,Athena, AU - LaBresh,Kenneth, AU - Forman,Daniel, AU - Brill,David, AU - Rand,William, AU - Gregory,Douglas, AU - Udelson,James E, AU - Lorell,Beverly, AU - Konstam,Varda, AU - Furlong,Kathleen, AU - Konstam,Marvin A, Y1 - 2004/08/16/ PY - 2004/8/18/pubmed PY - 2005/4/12/medline PY - 2004/8/18/entrez SP - 1450 EP - 5 JF - Circulation JO - Circulation VL - 110 IS - 11 N2 - BACKGROUND: Several trials support the usefulness of disease management (DM) for improving clinical outcomes in heart failure (HF). Most of these studies are limited by small sample size; absence of concurrent, randomized controls; limited follow-up; restriction to urban academic centers; and low baseline use of effective medications. METHODS AND RESULTS: We performed a prospective, randomized assessment of the effectiveness of HF DM delivered for 90 days across a diverse provider network in a heterogeneous population of 200 patients with high baseline use of approved HF pharmacotherapy. During a 90-day follow-up, patients randomized to DM experienced fewer hospitalizations for HF [primary end point, 0.55+/-0.15 per patient-year alive versus 1.14+/-0.22 per patient-year alive in control subjects; relative risk (RR), 0.48, P=0.027]. Intervention patients experienced reductions in hospital days related to a primary diagnosis of HF (4.3+/-0.4 versus 7.8+/-0.6 days hospitalized per patient-year; RR, 0.54; P<0.001), cardiovascular hospitalizations (0.81+/-0.19 versus 1.43+/-0.24 per patient-year alive; RR, 0.57; P=0.043), and days in hospital per patient-year alive for cardiovascular cause (RR, 0.64; P<0.001). Intervention patients showed a trend toward reduced all-cause hospitalizations and total hospital days. On long-term (mean, 283 days) follow-up, there was substantial attrition of the 3-month gain in outcomes, with sustained significant reduction only in days in hospital for cardiac cause. CONCLUSIONS: In a population with high background use of standard HF therapy, a DM intervention, uniformly delivered across varied clinical sites, produced significant short-term improvement in HF-related clinical outcomes. Longer-term benefit likely requires more active chronic intervention, even among patients who appear clinically stable. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15313938/Randomized_controlled_evaluation_of_short__and_long_term_benefits_of_heart_failure_disease_management_within_a_diverse_provider_network:_the_SPAN_CHF_trial_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000141562.22216.00?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -