gms | German Medical Science

Chronic heart failure (CHF) is a major cause of death and hospitalization. Furthermore, CHF is associated with considerable morbidity and impaired quality of life. A post-hospital discharge disease management program (DMP) in CHF may improve patients' symptoms and quality of life while reducing rehospitalizations and mortality. The Interdisciplinary Network for Heart Failure (INH) study is a multi-centre randomized controlled trial, which investigates the efficacy of a nurse-coordinated DMP in heart failure [1]. Using data from the INH study, we investigate whether compared with usual care, the new health care program has a positive impact on the health of patients discharged from hospital after cardiac decompensation.

We propose a multi-state modelling framework [2], within which we investigate various patient-relevant time-to-event endpoints. Our framework includes the model of competing risks and the illness-death model. A competing risks analysis disentangles a composite endpoint such as time until death or rehospitalization (whatever occurs first), by investigating both the time of admission-free survival and the event type, either readmission or death without prior hospitalization. In this context, an illness-death model also investigates death after rehospitalization. Within a competing risks setting we also consider time to cause-specific events such as time to death and the cause of death (e.g. cardiac death). We also pay attention to the multi-centre (clustering) structure of the data. Finally, we report on some problems related to the collection/preparation of the trial data and to the original analyses presented in Angermann et al. [1].

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.