Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: The SPAN-CHF trial

Kenneth A. LaBresh; C Kimmelstiel; D Levine; K Perry; AR Patel; A Sadaniantz; N Gorham; M Cunnie; L Duggan; L Cotter; P Shea-Albright; A Poppas; Kenneth A. LaBresh; D Forman; D Brill; W Rand; D Gregory; JE Udelson; B Lorell; V Konstam; K Furlong; MA Konstam

Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: The SPAN-CHF trial

Kimmelstiel, C., Levine, D., Perry, K., Patel, AR., Sadaniantz, A., Gorham, N., Cunnie, M., Duggan, L., Cotter, L., Shea-Albright, P., Poppas, A., LaBresh, K., Forman, D., Brill, D., Rand, W., Gregory, D., Udelson, JE., Lorell, B., Konstam, V., ... Konstam, MA. (2004). Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: The SPAN-CHF trial. Circulation, 110(11), 1450-1455. https://doi.org/10.1161/01.CIR.0000141562.22216.00

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Abstract

Background - Several trials support the usefulness of disease management (DM) for improving clinical outcomes in heart failure (HF). Most of these studies are limited by small sample size; absence of concurrent, randomized controls; limited follow-up; restriction to urban academic centers; and low baseline use of effective medications. <br><br>Methods and Results - We performed a prospective, randomized assessment of the effectiveness of HF DM delivered for 90 days across a diverse provider network in a heterogeneous population of 200 patients with high baseline use of approved HF pharmacotherapy. During a 90-day follow-up, patients randomized to DM experienced fewer hospitalizations for HF [primary end point, 0.55+/-0.15 per patient-year alive versus 1.14+/-0.22 per patient-year alive in control subjects; relative risk (RR), 0.48, P=0.027]. Intervention patients experienced reductions in hospital days related to a primary diagnosis of HF (4.3+/-0.4 versus 7.8+/-0.6 days hospitalized per patient-year; RR, 0.54; P<0.001), cardiovascular hospitalizations (0.81&PLUSMN;0.19 versus 1.43&PLUSMN;0.24 per patient-year alive; RR, 0.57; P=0.043), and days in hospital per patient-year alive for cardiovascular cause (RR, 0.64; P<0.001). Intervention patients showed a trend toward reduced all-cause hospitalizations and total hospital days. On long-term (mean, 283 days) follow-up, there was substantial attrition of the 3-month gain in outcomes, with sustained significant reduction only in days in hospital for cardiac cause. <br><br>Conclusions - In a population with high background use of standard HF therapy, a DM intervention, uniformly delivered across varied clinical sites, produced significant short-term improvement in HF-related clinical outcomes. Longer-term benefit likely requires more active chronic intervention, even among patients who appear clinically stable