Patient With Chronic Heart Failure as a Participant in the Treatment Process: the Role of Structured Training And Outpatient Observation (on the Anniversary of the Study Chance).

Abstract

Aim      The article presents the principal results and conclusions of the study "SCHool and outpAtient moNitoring of patients with Cardiac failurE (CHANCE)", organized by the Society of Experts in Heart Failure.Material and methods  CHANCE was a multicenter randomized study. Patients in the intervention group (IG) received the Structured Education and Flexible Outpatient Control Model, that included telephone contacts plus an additional visit if necessary. The planned visits for the IG and control group (CG) were scheduled at 3, 6, and 12 months. 360 IG patients and 385 CG patients were included in the analysis. In the main analysis of the CHANCE study, the efficacy was assessed by the impact on the hard endpoints (mortality and rehospitalizations), clinical condition, functional capabilities, quality of life, anxiety and depressive symptoms, and cost-effectiveness. Also, a comprehensive assessment was performed of the prevalence, structure, and dynamics of anxiety and depressive symptoms depending on the changes in the clinical condition.Results Mortality significantly differed between the groups: 30 (8.3%) patients died in the IG and 50 (13.0%) in the CG. The relative risk of death was 0.68, 95% confidence interval 0.42-0.99, p = 0.044. To prevent one death, it was necessary to educate and monitor 21 patients with clinically evident chronic heart failure (CHF) according to the principles of the CHANCE program. According to the dynamics of the Clinical Condition Assessment Scale (SCAS), the score difference between the groups was 1.7 (p<0.001) after 12 months of follow-up in favor of the IG group. In 12 months, the increase in the 6-minute walk test distance was 98.7 m in the IG and 42.9 m in the CG (p<0.001). The change from baseline in the Minnesota questionnaire total score was 15.3 ± 16.3 in the IG (p<0.001) and 6.2 ± 15.3 in the CG (p<0.001). The odds of developing depressive symptoms increased with each SCAS point by 19% (p = 0.0002). The odds of developing anxiety symptoms increased with each SCAS point by 12% (p = 0.02). The odds of developing the most unfavorable combination of anxiety and depressive symptoms increased with each SCAS point by 41% (p = 0.000002). The participation of patients in the study increased the odds of reducing the anxiety and depressive symptoms in patients with CHF by 2.35 times (p<0.0001), to a greater extent in women.Conclusion      The CHANCE study that included 42 centers in 23 cities of Russia became the forerunner of the first initiatives in organizing the outpatient follow-up of patients in real clinical practice and serves as a vivid example of the importance of national research programs. Their implementation allows obtaining results that can be scaled up throughout the country to make an important contribution to the improvement of medical care for patients with CHF.