Patient-Centered Disease Management | Clinical Trial - PCDM
Description:
The goal of the trial was to evaluate a collaborative care patient-centered disease management program among subjects with heart failure and reduced health status.
Contribution to the Literature: PCDM was unable to show that a collaborative care program for heart failure patients improved functional status.
Study Design
- Randomized
- Parallel
- Stratified
Subjects with heart failure and reduced health status were randomized to a collaborative care patient-centered disease management program (n = 187) versus usual care (n = 197).
The collaborative care team consisted of a nurse coordinator, a primary care physician, a cardiologist, and a psychiatrist. The team met weekly to review data and recommend management changes. Patients who screened positive for depression received antidepression management.
- Total number of enrollees: 392
- Duration of follow-up: 12 months
- Mean patient age: 67 years
- Percentage female: 5%
- Percentage diabetics: 53%
Inclusion criteria:
- Patients with a diagnosis of heart failure in the prior year irrespective of type
- Kansas City Cardiomyopathy Questionnaire (KCCQ) <60. KCCQ <60 is consistent with significant heart failure symptoms, limited functional capacity, and poor quality of life.
Exclusion criteria:
- Severe cognitive or psychiatric impairment
- Nursing home residence
- Limited lifespan
- Prior heart transplantation
- Alcohol abuse
Other salient features/characteristics:
- 52% had a nonischemic etiology for heart failure
- 46% had normal left ventricular ejection fraction
- 42% had a positive depression screen
Principal Findings:
At baseline, the mean KCCQ score was 37.9 points in the collaborative care group versus 36.9 points in the usual care group (p = 0.48). At 1 year, the mean change in KCCQ was 13.5 points in both groups (p = 0.97 between groups).
Secondary outcomes: One-year mortality was 4.3% in the collaborative care group versus 9.6% in the usual care group (p = 0.04). There were less depressive symptoms among the collaborative care group.
Interpretation:
Among patients with heart failure and reduced health status, as defined by the KCCQ, a collaborative care management program was unable to improve symptoms compared with usual care. The collaborative care program was associated with a reduction in mortality and less depression symptoms; however, these were secondary outcomes and need to be interpreted cautiously. Heart failure management programs have yielded mixed results regarding their efficacy.
References:
Bekelman DB, Plomondon ME, Carey EP, et al. Primary Results of the Patient-Centered Disease Management (PCDM) for Heart Failure Study: A Randomized Clinical Trial. JAMA Intern Med 2015;Mar 30:[Epub ahead of print].
Keywords: Heart Failure, Cognition, Depression, Depressive Disorder, Disease Management, Follow-Up Studies, Health Status, Nursing Homes, Psychiatry, Quality of Life, Surveys and Questionnaires, Primary Prevention
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