INSERM, CIC-EC, CIE6, Nancy F-54 000, France; CHU Nancy, Epidémiologie et Evaluation Cliniques, Nancy F-54 000, France; Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Nancy F-54 000, France.
Int J Cardiol. 2013 Oct 9;168(4):3652-8. doi: 10.1016/j.ijcard.2013.05.090. Epub 2013 Jul 1.
The purpose of this study was to assess the effectiveness of a disease management program (DMP) in heart failure (HF) on the incidence of HF hospitalizations and related costs in a real-world population-based setting.
Insuffisance CArdiaque en LORraine (ICALOR), a DMP for HF was established in 2006 in the French region of Lorraine. Patients were enrolled after an index HF hospitalization. They received educational and home-visit monitoring programs by HF-trained nurses. General physicians received automatic alerts about patients' significant clinical or biological changes. We used the ICALOR and the national diagnostic related group databases to conduct a comparison of time-series trends in HF hospitalizations in France. The economic impact was obtained using the national scale of costs in France.
The median age of the 1222 patients recruited before 2010 was 76 years, and 65% were male. Upon enrollment, patients essentially presented with NYHA class II (n=537, 48%) or class III (n=359, 32%) symptoms. One-year mortality rate was 20.3%. The implementation of the ICALOR program was associated with a reduction in HF hospitalizations in Lorraine estimated by an absolute difference between the number of hospitalizations observed in the Lorraine region and that expected had it been similar to that observed in the whole country of -7.19% in 2010. The estimated annual hospital cost saved by ICALOR was €1,927,648 in 2010.
Coordinated DMP of HF might improve outcome cost-effectively when implemented in a real-world population setting, and was associated in Lorraine with a substantial modification of the trend of HF hospitalizations.
本研究旨在评估心力衰竭（HF）疾病管理计划（DMP）在真实人群环境下对 HF 住院率和相关成本的影响。
Insuffisance CArdiaque en LORraine（ICALOR）是 2006 年在法国洛林地区成立的 HF DMP。在 HF 住院后，患者被纳入研究。他们接受 HF 培训护士的教育和家访监测计划。普通医生会收到关于患者重要临床或生物学变化的自动警报。我们使用 ICALOR 和国家诊断相关组数据库来比较法国 HF 住院时间序列趋势。使用法国国家成本规模获得经济影响。
2010 年前招募的 1222 名患者的中位年龄为 76 岁，65%为男性。入院时，患者主要表现为 NYHA Ⅱ级（n=537，48%）或Ⅲ级（n=359，32%）症状。一年死亡率为 20.3%。ICALOR 计划的实施与洛林地区 HF 住院率的降低有关，这一降低幅度通过洛林地区实际观察到的住院人数与如果与全国其他地区相似的情况下预计的住院人数之间的绝对差异来估计，2010 年为-7.19%。2010 年，ICALOR 节省的年度住院费用估计为 1927648 欧元。
在真实人群环境中实施协调一致的 HF DMP 可能会以有成本效益的方式改善预后，并且在洛林地区，HF 住院趋势发生了实质性改变。
