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Canadian Journal of Cardiology

Conceptual Model for Heart Failure Disease Management

Published:January 02, 2014DOI:https://doi.org/10.1016/j.cjca.2013.12.020

      Abstract

      The objective of this review is to propose a conceptual model for heart failure (HF) disease management (HFDM) and to define the components of an efficient HFDM plan in reference to this model. Articles that evaluated 1 or more of the following aspects of HFDM were reviewed: (1) outpatient clinic follow-up; (2) self-care interventions to enhance patient skills; and (3) remote evaluation of worsening HF either using structured telephone support (STS) or by monitoring device data (telemonitoring). The success of programs in reducing readmissions and mortality were mixed. Outpatient follow-up programs generally resulted in improved outcomes, including decreased readmissions. Based on 1 meta-analysis, specialty clinics improved outcomes and nonspecialty clinics did not. Results from self-care programs were inconsistent and might have been affected by patient cognitive status and educational level, and intervention intensity. Telemonitoring, despite initially promising meta-analyses demonstrating a decrease in the number and duration of HF-related readmissions and all-cause mortality rates at follow-up, has not been shown in randomized trials to consistently reduce readmissions or mortality. However, evidence from device monitoring trials in particular might have been influenced by technology and design issues that might be rectified in future trials. Results from the literature suggest that the ideal HFDM plan would include outpatient follow-up at an HF specialty clinic and continuous education to improve patient self-care. The end result of this plan would lead to better understanding on the part of the patient and improved patient ability to recognize and respond to signs of decompensation.

      Résumé

      L’objectif de cette revue est de proposer un modèle conceptuel de prise en charge de l’insuffisance cardiaque (PCIC) et de définir les composantes d’un plan efficace de PCIC faisant référence à ce modèle. Les articles qui évaluaient 1 des aspects suivants ou plus de la PCIC ont été passés en revue : 1) le suivi en consultation externe; 2) les interventions d’autoadministration de soins pour améliorer les compétences du patient; 3) l’évaluation à distance de la détérioration de l’IC soit en utilisant le soutien téléphonique structuré ou les données du dispositif de surveillance (télésurveillance). Le succès des programmes sur la diminution des réadmissions et de la mortalité était mitigé. Les programmes de suivi en consultation externe entraînaient habituellement l’amélioration des résultats incluant la diminution des réadmissions. Selon 1 méta-analyse, les cliniques spécialisées amélioraient les résultats, mais les cliniques non spécialisées ne les amélioraient pas. Les résultats des programmes d’autoadministration de soins étaient contradictoires et pourraient avoir été influencés par l’état cognitif du patient et le niveau d’études, ainsi que l’intensité de l’intervention. La télésurveillance, malgré les méta-analyses initialement prometteuses démontrant une diminution du nombre et de la durée des réadmissions liées à l’IC et les taux de mortalité toutes causes confondues au suivi n’a pas montré réduire de manière constante au cours des essais aléatoires les réadmissions ou la mortalité. Cependant, les données scientifiques provenant des essais sur la télésurveillance au moyen de dispositifs auraient été en particulier influencées par les problèmes de conception et de technologie qui pourraient être rectifiés lors d’essais futurs. Les résultats provenant de la littérature suggèrent que le plan idéal de PCIC inclurait le suivi en consultation externe dans une clinique spécialisée en IC et un enseignement continu pour améliorer l’autoadministration des soins. Le résultat final de ce plan mènerait à une meilleure compréhension de la part du patient et à l’amélioration de l’habileté du patient à reconnaître les signes de décompensation et à y réagir.
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