Clinical efficacy and cost efficiency of different strategies for outpatient care of patients with pronounced chronic heart failure
<i>Background.</i> Proper outpatient management of CHF patients improves patient compliance, increases efficiency of patient self-control, and reduces the number of repeated hospitalizations and healthcare expenses. <i>Aim.</i> Studying clinical efficacy and cost efficiency of outpatient self-control in patients with severe CHF. Materials and methods. 122 patients with NYHA III–IV FC CHF were randomized to 3 groups: Group I was a group of outpatient self-control following in-hospital training at a CHF Patient School; Group II was a group of standard outpatient management following the training at the in-hospital CHF Patient School; Group III was a control group. If edema / dyspnea developed in Group I patients, they could self-administer torasemide under guidance of blood potassium, sodium and creatinine values. If the therapy failed, Group I patients consulted a doctor by phone. During the inpatient treatment and at 3, 6 and 9 months of the outpatient follow-up, number and duration of repeated hospitalizations, requirement for emergency care, functional status by results of 6‑min walk test, and calculated GFR were evaluated. Cost efficiency of different kinds of outpatient management was analyzed. <i>Results.</i> Death rate did not significantly differ between the study groups. Median time to the first admission was 187 days for Group I, 124 days for Group II, and 118 days for Group III. Both total duration of hospital stay and requirement for emergency care were significantly less in Group I compared to Groups II and III (p<0.001 for both comparisons). Cost efficiency of implementing the outpatient self-control strategy was 500,409 rub. At Month 9 of the study, the mean 6‑min walk test distance increased from 174.5 m to 248.5 m (p=0.001) in Group I and did not significantly change in Groups II and III. In Group I, GFR remained stable throughout the follow-up period and was 78.9 ml / min / 1.73 m <sup>2</sup> (p=0.4) at the end of study; in Groups II and III, GFR decreased significantly and comparably. Conclusion. Implementation of the outpatient self-control strategy reduces the number of repeated hospitalizations, decreases the requirement for emergency care, and improves treatment compliance and functional status of CHF patients. Clinical efficacy and cost efficiency of in-hospital CHF Patient Schools was found to be inadequate without subsequent appropriate and supervised outpatient self-control.