Ramachandran, KHusain, NMaikhuri, RSeth, SVij, AKumar, MSrivastava, NPrabhakaran, DAiran, BReddy, K Srinath2007-03-072009-06-032007-03-072009-06-032007-03-07Ramachandran K, Husain N, Maikhuri R, Seth S, Vij A, Kumar M, Srivastava N, Prabhakaran D, Airan B, Reddy KS. Impact of a comprehensive telephone-based disease management programme on quality-of-life in patients with heart failure. National Medical Journal of India. 2007 Mar-Apr; 20(2): 67-73http://imsear.searo.who.int/handle/123456789/118427BACKGROUND: Disease management programmes for patients with heart failure have improving the quality-of-life (QOL) of patients with heart failure. METHODS: Patients attending the heart failure clinic were randomized into 2 groups of 25 patients each. The control group was managed in the heart failure clinic and the intervention group underwent the following additional interventions: (i) interactive sessions with the patient and spouse informing them about the disease, drugs, and self-management of fluid intake and diuretic dose; (ii) a telephonic helpline was established and regular telephone calls made to reinforce the information and modify drug dosages. The QOL was assessed using the Kansas City Cardiomyopathy questionnaire. Functional capacity was assessed by the 6-minute walk test. Continuous variables were compared with the Student t-test (paired or unpaired). RESULTS: There was significant improvement in the QOL and functional capacity of patients in the intervention group compared with controls over a 6-month period. The mean (SD) QOL scores in the intervention group improved from 60.0 (23.6) to 76.3 (17.3) but did not change significantly in the control group (62.2 [22.6] to 63.4 [21.9]). There was a similar improvement in the functional capacity measured by the 6-minute walk test in the intervention group (from 202.2 [81.5] to 238.1 [100.9] metres, p < 0.05) but not in the control group (193.8 [81.5] to 179.7 [112.0] metres). In the intervention group, the use of beta-blockers and angiotensin-converting enzyme inhibitors was similar but in the intervention group patients were placed on higher doses. There was no significant difference in the number of emergency room visits or admissions in either group. For every 20 patients in the intervention group, 14 patients improved by 1 functional class while in the control group this was observed in only 3 patients for every 20 treated. CONCLUSION: This study demonstrates that in the setting of a developing country, improvement in QOL by intensive management of heart failure patients through a heart failure programme with telephonic reinforcement and a helpline is greater than that usually achieved with drug therapy in a routine heart failure clinic.engAdrenergic beta-Antagonists --therapeutic useAdultAngiotensin-Converting Enzyme Inhibitors --therapeutic useComprehensive Health CareCounselingDisease ManagementFemaleHeart Failure --drug therapyHotlinesHumansIndiaMaleMiddle AgedOutcome and Process Assessment (Health Care)Patient Education as TopicProgram EvaluationQuality of Life --psychologyQuestionnairesJournal Article