Which patients with heart failure respond best to multidisciplinary disease management?

Background: Multidisciplinary disease management approaches have been shown to decrease resource use in selected samples of patients with heart failur e. We remain uncertain regarding the effectiveness of this approach in a ge neral heart failure population and who can be expected to benefit most. The purpose of this study was to test the effectiveness of a multidisciplinary disease management intervention in an unselected population of patients wi th heart failure and to determine if subgroups could be identified in which the intervention is most effective. Methods and Results: Two hundred forty patients with heart failure who were matched on preadmission functional status, comorbidity, and age participat ed in a quasi-experimental clinical trial. Half (n = 120) were given a mult idisciplinary disease management intervention, whereas the other half (n = 120) received usual care. Data on acute care resource use were collected 3 and 6 months after enrollment. No intervention effect was seen in the prima ry analysis. When the data were analyzed by preadmission functional status (I to IV), acute care resource use was lower in the class II intervention p atients. Class I intervention patients had a 288% increase in total costs a nd a 14-fold increase in heart failure costs. A model of predictor variable s explained 17.2% of the variance in heart failure readmission at 3 months. Conclusions: An intervention of this type and intensity is recommended prim arily for functional class II heart failure patients. Increases in cost in class I patients may have resulted from improved access to care.