CONTACT: Mike Goodkind (415) 723-6911
FOR COMMENT: Dr. Robert F. DeBusk (415) 725-5007
Phone calls improve results for heart failure patients, provide model for assessing care
STANFORD -- Frequent phone calls from specially trained nurses significantly improved the health of heart failure patients in a study reported this month in the American Journal of Cardiology.
The study also offers strong evidence that quality of care can be objectively measured, said Dr. Robert F. DeBusk, senior author of the report.
The research project followed 51 Northern California patients for about five months after they were hospitalized for treatment of heart failure. "With this kind of follow-up, we can measure how good a job you're doing for a specified group of patients, and presumably we can apply our methods to improve health care for all such patients," said DeBusk, a professor of medicine (cardiovascular medicine) at Stanford University Medical Center.
The study applied a case management system called MULTIFIT, developed over the past several years at the Stanford Cardiac Rehabilitation Program in collaboration with the Kaiser Permanente Medical Care Program of Northern California.
In the MULTIFIT system, specially trained nurses educate patients during their stay in the hospital, then keep in touch through regular phone calls, starting at weekly intervals. The nurses also offer feedback to patients and their physicians.
MULTIFIT has already been shown to help patients reduce risk factors of coronary artery disease -- for example, by helping them to quit smoking or to lower their blood cholesterol. "But this is the first study of the MULTIFIT system that shows improved health status and reductions in rehospitalizations, trips to the emergency room and office visits for problems related to heart failure," DeBusk said.
Since failure to comply with recommended care is a common cause of hospital readmission for heart failure, MULTIFIT was designed to help patients understand their health needs and comply with dietary advice and drug therapy. Selected patients treated at the Kaiser Permanente Health Care Center in Hayward, Calif., filled out questionnaires that served as the foundation of the systematic phone calls from the nurse case managers.
Participants' hospitalization rates were 87 percent lower during the five-month follow-up period than during the 12 months before enrollment, the researchers found. In company hospitalization rates, the team used a formula that adjusted for the follow-up period's shorter time span.
During the study, the participants' average daily sodium intake fell by 38 percent and their average daily medication doses increased to the levels recommended by national guidelines. Close monitoring by phone enabled the nurses to find the most effective level of medication for each individual, DeBusk said.
The lead author of the study was Dr. Jeffrey A. West, director of the Cardiopulmonary Section in the Livermore Division of the Veterans Affairs Palo Alto Health Care System. Other authors included Nancy H. Miller, associate director of the Stanford Cardiac Rehabilitation Program; Dr. Michael B. Fowler, associate professor of medicine (cardiovascular medicine); and two Kaiser Hayward physicians, Dsr. George Greenwald and Robert S. Heller.
The research was funded by a grant from the Robert Wood Johnson Foundation in Princeton, N.J. Work by West was supported by the Department of Veterans Affairs and the American College of Cardiology/Merck Adult Cardiology Fellowship Awards program.
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