Patient-Centered Disease Management | Clinical Trial - PCDM
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.
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%
- 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.
- 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
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.
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.
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, Questionnaires, Primary Prevention
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