Progress in Cardiovascular Nursing Fall 2007 196 www.lejacq.com ID: 6483 H eart failure (HF) poses a sig- nificant burden to the health care system in the United States. The estimated incidence and prevalence of this condition is 5 million and 550,000, respectively. The number of hospital discharges attributed to HF in 2004 was 1,099,000, a 175% increase since 1979, 1 making it the largest expenditure by Medicare ben- eficiaries and the leading cause of hos- pital admissions in individuals aged 65 years and older. 2,3 Furthermore, the cost to treat HF was $33.2 billion in 2007. 1 Clearly, cost-effective strate- gies that improve patient outcomes (ie, reduce hospitalization) are needed in the HF population. Disease management programs have gained considerable attention in a number of patient populations including HF. An accepted definition of disease management is “a system of coordinated health care interventions and communications for populations with conditions in which patient self- care efforts are significant.” 4 The goal of disease management programs is to improve compliance with interven- tions shown to positively impact out- come (decreased health care costs and hospitalizations and prolonged surviv- al), typically on an outpatient basis. A number of studies have demonstrated that disease management programs reduce event rates in patients with HF. 5–7 Furthermore, disease manage- ment programs in HF appear to be cost-effective. 8,9 While the positive findings from disease management pro- grams in HF continue to mount, there is still no uniform consensus on how they should be administered. Akosah and colleagues 6 reported improved survival using a disease management program, which incorporated a mul- tidisciplinary approach, with a combi- nation of frequent one-on-one initial clinic visits and phone contact by a nurse practitioner. Fonarow and asso- ciates 10 likewise reported a significant reduction in hospital admissions using comprehensive group and individual education sessions before discharge for patients awaiting heart transplant, which was reinforced by outpatient clinic visits. Lastly, Kimmelstiel and colleagues 11 reported a significant reduction in hospitalizations with a program utilizing home visits by a nurse case manager, reinforced by weekly or biweekly telephone con- tact. Based on this body of evidence, the American College of Cardiology/ American Heart Association practice guidelines 12 for HF management has recommended the use of disease man- agement systems in this population. Ideally, a disease management pro- gram should be able to optimize the improvement in clinical outcome at the lowest cost and utilization of health care resources possible. The essential components of a disease management program are, however, yet to be defined. The present investi- gation explores the impact of adding a Original Paper Impact of the Implementation of Telemanagement on a Disease Management Program in an Elderly Heart Failure Cohort Miguel Gambetta, MD; 1 Patrick Dunn, MS; 2 Dawn Nelson, MS, NP-BC, CNS; 1 Bobbi Herron, MS, APRN, BC-CNS; 1 Ross Arena, PhD, PT 3 The purpose of the present investigation is to examine the impact of a telemanage- ment component on an outpatient disease management program in patients with heart failure (HF). A total of 282 patients in whom HF was diagnosed and who were enrolled in an outpatient HF program were included in this analysis. One hun- dred fifty-eight patients additionally participated in a self-directed telemanagement component. The remaining 124 patients received care at an HF clinic but declined telemanagement. During the 7-month tracking period, 19 patients in the HF clinic plus telemanagement group and 53 patients in the HF clinic only group were hospi- talized for cardiac reasons (log rank, 36.0; P<.001). The HF clinic only group had a significantly higher risk for hospitalization (hazard ratio, 4.0; 95% confidence inter- val, 2.4–6.7; P<.001). The results of the present study indicate that telemanagement is an important component of a disease management program in patients with HF. (Prog Cardiovasc Nurs. 2007;22:196–200) © 2007 Le Jacq From the Community Health Care System, Munster and Hobart, IN; 1 Las Colinas Medical Center, Irving, TX; 2 Department of Physical Therapy, Virginia Commonwealth University, Health Sciences Campus, Richmond, VA 3 Address for correspondence: Ross Arena, PhD, PT, Assistant Professor, Department of Physical Therapy, Box 980224, Virginia Commonwealth University, Health Sciences Campus, Richmond, VA 23298-0224 E-mail: raarena@.vcu.edu Manuscript received December 18, 2006; revised February 9, 2007; accepted February 13, 2007 Progress in Cardiovascular Nursing® (ISSN 0889-7204) is published Quarterly (March, June, Sept., Dec.) by Le Jacq, a Blackwell Publishing imprint, located at Three Enterprise Drive, Suite 401, Shelton, CT 06484. Copyright © 2007 by Le Jacq. All rights reserved. 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