July 20, 2010
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DIAL: Telephone-based intervention improved outcomes in patients with HF

Ferrante D. J Am Coll Cardiol. 2010;56:372–378.

Konstam M. J Am Coll Cardiol. 2010;56:379-381.

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Patients with HF whose physicians intervened over the telephone to assess major outcomes and compliance regarding lifestyle factors had a lower rate of death and hospitalization for HF vs. the non-intervention group, according to findings of the DIAL trial.

The trial was a randomized, controlled, open-label, multicenter trial featuring 1,518 patients with HF. After the trial’s completion, researchers followed up with patients up to 3 years to determine major outcomes and evaluate three key compliance indicators — diet, weight control and treatment. The objective was to improve diet and treatment compliance, promote exercise, encourage early visits if signs of clinical deterioration were detected, and monitor symptoms, weight and edema.

Researchers found that the rate of death and hospitalization was lower in the intervention group 1 year (37.2% vs. 42.6%; RR=0.81; 95% CI, 0.69-0.96) and 3 years (55.7% vs. 57.5%; RR= 0.88; 95% CI, 0.77-1.00) after the intervention ended. They concluded the main reason for this was because of the reduction in HF admission (after 3 years, 28.5% vs. 35.1%; RR=0.72; 95% CI, 0.60-0.87). Additionally, patients who showed improvement in one or more of the three compliance indicators had a lower risk of events.

This led the researchers to conclude that the outcomes of patients with HF can improve with the implementation of simple and low-cost follow-up programs. “Patients who change their behavior early during the intervention are at lower risk of events. In the light of the available evidence, the implementation of these programs could become a standard of care for patients with HF,” they wrote.

In an accompanying editorial, Marvin A. Konstam, MD, of Tufts Medical Center in Boston and Varda Konstam, PhD, of the University of Massachusetts in Boston, said the results point to the possibility of improving outcomes for the growing population with HF.

“They challenge us to reconstruct our health care system into one that aligns providers to offer integrated, multidisciplinary, cost-effective programs — including empowerment of patients themselves — to generate a sustained improvement in health care outcomes,” they concluded.

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