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].

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: Heart Failure, Cognition, Depression, Depressive Disorder, Disease Management, Follow-Up Studies, Health Status, Nursing Homes, Psychiatry, Quality of Life, Questionnaires, Primary Prevention


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