Marina Ferrari

Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by day-hospital and usual care

OBJECTIVES This study compared the effectiveness and cost/utility ratio between a heart failure (HF) management program delivered by day-hospital (DH) and usual care in chronic heart failure (CHF) outpatients. BACKGROUND Previous studies showed that about 50% of readmissions for CHF can be prevented by a multidisciplinary approach However, the performance, effectiveness, and cost/utility ratio of a process of HF outpatient management related to evidence-based medicine have not been considered. METHODS A total of 234 prospective patients discharged by a HF Unit were randomized to two management strategies: 122 patients to usual community care and 112 patients to a HF management program delivered by the DH. Management (rate of readmissions, therapeutic interventions), functional parameters (New York Heart Association [NYHA] functional class, left ventricular diameters, and ejection fraction, deceleration time of early diastolic mitral flow, peak oxygen uptake, and mitral regurgitation) and hard outcomes (cardiac death and urgent cardiac transplantation) were evaluated. The cost/utility ratios of the two strategies were compared. RESULTS After 12 3 months of follow-up, the individual rate access in DH was 5.5 3.8 days. The DH subjects were readmitted to the hospital less frequently than were the usual-care group patients (13 vs. 78, p 0.00001). Patients allocated to usual-care management showed heterogeneous changes in NYHA functional class (13% improved and 16% worsened p NS); In contrast, the DH group showed significant changes in NYHA functional class (23% improved and 11% worsened, p 0.009). Hard cardiac events in the one-year follow-up occurred in 25/234 (10.6%) patients; cardiac death occurred in 21/122 (17.2%) of the community group and in 3/112 (2.7%) in the DH group (p 0.0007). One DH patient underwent urgent transplantation. Comparison of the two managerial models by Cox regression analysis showed that DH management significantly protected against the appearance of hard events (relative risk [RR] 0.17; confidence interval [CI] 0.06 to 0.66). The cost/utility ratio of the two management strategies was similar (usual care

Home telemonitoring of chronic heart failure patients: novel system architecture of the home or hospital in heart failure study

2,409 vs. DH

Heart failure case disease management program: a pilot study of home telemonitoring versus usual care

2,244). The incremental analysis revealed a cost savings of

Home telemonitoring of vital signs and cardiorespiratory signals in heart failure patients: system architecture and feasibility of the HHH model.

1,068 for each quality-adjusted life year gained. The cost/utility ratio for the integration of DH management of CHF was

Training fisico domiciliare nello scompenso cardiaco cronico: studio osservazionale sui fattori condizionanti l'aderenza al programma.

19,462 (CI

[Presentation of the Psycho-Cardiological schedule and convergence levels analyses among the psycho-cardiological screening and the psychological assessment].

13,904 to

[First definition of minimal care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology].

34,048). CONCLUSIONS A heart failure outpatient management program delivered by a DH can reduce mortality and morbidity of CHF patients. This management strategy is cost-effective and has an equitable value from a societal point of view. (J Am Coll Cardiol 2002;40:1259 ‐ 66)

Documento preliminare alla definizione degli interventi Minimal Care infermieristici, fisioterapici, dietistici e psicologici attuabili nell'ambito della Cardiologia Riabilitativa e Preventiva First definition of Minimal Care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology

The HHH (home or hospital in heart failure) study is a European Community multicenter trial aimed at assessing in a population of chronic heart failure patients 3 incremental home telemonitoring strategies against usual clinical practice. End points are rehospitalization, quality of life, mortality and cost-efficacy. Easy accessibility by the patient and low management costs are the two basic criteria that have guided the design of the architecture of the HHH telemonitoring system. Voice messages, vital signs and long-term cardiorespiratory data are periodically transmitted by the patients at home to a centralized interactive voice response system shared by several hospitals. From there, relevant data are automatically routed to the pertaining medical staff. The HHH technical infrastructure has been completed and tested in the 3 countries involved in the study and enrolment is in progress. Preliminary results on the feasibility of the HHH telemonitoring model are available.