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Context: During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates.Objective: To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI.Design, Setting, and Patients: Observational study using administrative data and a validated risk model to evaluate 3,195,672 discharges in 2,755,370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI.Main Outcome Measure: Hospital-specific 30-day all-cause RSMR.Results: At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%.Conclusion: Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To characterize the relationship between hydroxymethylglutaryl-CoA reductase inhibitors (statins) and outcomes in older persons with acute myocardial infarction (AMI). DESIGN: Observational study. SETTING: Acute care hospitals in the United States from April 1998 to June 2001. PARTICIPANTS: Medicare patients aged 65 and older with a principal discharge diagnosis of AMI (N=65,020) who did and did not receive a discharge prescription for statins. MEASUREMENTS: The primary outcome of interest was all-cause mortality at 3 years after discharge. RESULTS: Of 23,013 patients with AMI assessed, 5,513 (24.0%) were receiving a statin at discharge. Nearly 40% of eligible patients (n=8,452) were aged 80 and older, of whom 1,310 (15.5%) were receiving a statin at discharge. In a multivariable model taking into account demographic, clinical, physician and hospital characteristics, and propensity score, discharge statin therapy was associated with significantly lower 3-year mortality (hazard ratio (HR)=0.89 (95% confidence interval (CI)=0.83-0.96)). In an analysis stratified by age, discharge statins were associated with lower mortality in patients younger than 80 (HR=0.84, 95% CI=0.76-0.92) but not in those aged 80 and older (HR=0.97, 95% CI=0.87-1.09). CONCLUSION: Statin therapy is associated with lower mortality in older patients with AMI younger than 80 but not in those aged 80 and older, as a group. This finding questions whether statin efficacy data in younger patients can be broadly applied to the very old and indicates the need for further study of this group. Copyright © 2006 by Elsevier Science (USA). [ABSTRACT FROM AUTHOR]

Background: Hospitals are under increasing pressure to measure and improve quality of care, and substantial resources are being directed at a variety of quality improvement strategies; however, the evidence base supporting these strategies is limited.Objective: We sought to identify quality improvement efforts that were associated with hospitals' beta-blocker prescription rates after acute myocardial infarction (AMI).Research Design: This was a cross-sectional study using data from a telephone survey of quality management directors at participating hospitals linked with patient-level data from the National Registry of Myocardial Infarction (NRMI) during the study period, October 1997 to September 1999.Subjects: A total of 60,363 patients discharged with a confirmed AMI from 234 US hospitals were included.Measures: Hospital performance based on beta-blocker rates characterized as the top 20%, lower 20%, and middle 40% of hospitals; reported quality improvement efforts, including system interventions, physician leadership, administrative support for quality improvement efforts, and data feedback; hospital teaching status, AMI volume, geographic location, and ownership type.Results: The mean hospital-specific beta-blocker rate was 60.2%; however, the variation in beta-blocker use across hospitals was marked (range, 19.4-89.3%, standard deviation, 12.7% points), and quality improvement efforts used varied greatly. None of the quality improvement efforts distinguished higher from medium performers; the higher and the medium performers together were distinguished from the lower performers in organizational support for quality improvement efforts (fully adjusted odds ratio [OR] 1.89, 95% confidence interval [CI] 1.17-3.06) and physician leadership (fully adjusted OR 9.88, 95% CI 2.64-37.02). Among the specific quality improvement interventions, only standing orders were associated with having higher/medium versus lower performance, and their effect had borderline significance (fully adjusted OR 2.26, 95% CI 0.97-5.30, P = 0.07).Conclusions: Our findings highlight the organizational environment, specifically the absence of administrative support or physician leadership for quality improvement, as an important correlate of poor beta-blocker rates after AMI. Future studies are needed to isolate hospital quality improvement efforts that are associated with superior performance. [ABSTRACT FROM AUTHOR]

Background: National surveys indicate improvement in beta-blocker use after acute myocardial infarction (AMI) over time; however, these data could obscure important variation in improvement at individual hospitals. Our objective was to characterize the hospital-level variation in the improvements in beta-blocker prescription rates after AMI and to identify hospital characteristics that were associated with hospital improvement rates after adjustment for patient demographic and clinical characteristics.Methods and Results: We used data (n = 335,244 patients with AMI discharged from 682 hospitals) from the National Registry of Myocardial Infarction (NRMI) and from the American Hospital Association Annual Survey of Hospitals and hierarchical modeling to examine the associations between hospital characteristics and hospital-level rates of change in beta-blocker use during 1996-1999. On average, hospital rates of beta-blocker use for patients with AMI increased 5.9 percentage points (standard deviation, 9.7 percentage points) from the premidpoint time period (April 1996-February 1998) to the postmidpoint time period (March 1998-September 1999) of the study. The range in hospital-level changes in beta-blocker rates was substantial, from a decline of -50.0 percentage points to an increase of +35.7 percentage points. AMI volume and teaching status, geographic region, and initial beta-blocker use rates were associated with rate of improvement, but the magnitude of these effects was modest.Conclusions: The study reveals marked hospital-level variation in improvement in beta-blocker use after AMI. Several hospital characteristics were associated with this improvement, but they are weak predictors of hospital-based improvement in the use of beta-blockers. [ABSTRACT FROM AUTHOR]

Objectives: To determine if there are sex differences in the use of coronary revascularization in elderly patients after acute myocardial infarction (AMI), and if sex differences vary by type of revascularization therapy.Design: Retrospective analysis of medical record data.Setting: US acute-care nongovernment hospitals.Patients: A total of 66,830 Medicare patients > or =65 years old hospitalized with AMI.Interventions: None.Measurements and Results: We assessed sex differences in the use of coronary revascularization within 60 days of hospital admission among patients who had undergone cardiac catheterization. Multivariable logistic regression models were used to derive risk-standardized rates of any coronary revascularization, coronary artery bypass graft (CABG) surgery, and percutaneous coronary intervention (PCI) adjusted for patient and hospital characteristics. Women had lower crude overall rates of coronary revascularization compared with men (65.2% vs 68.7%, p < 0.001). Multivariable adjustment reduced the sex difference in the overall coronary revascularization rate from 3.5 to 2.1% (66.0% women vs 68.1% men, p = 0.001). Sex differences in coronary revascularization use, however, varied by type of revascularization therapy. Women had lower risk-standardized rates of CABG surgery compared with men (27.0% vs 32.9%, p < 0.001), but had higher risk-standardized rates of PCI (42.0% vs 38.2%, p < 0.001), particularly among patients > 85 years old (45.8% vs 38.9%, p = 0.011).Conclusions: Among Medicare patients hospitalized with AMI, women are slightly less likely to undergo coronary revascularization after cardiac catheterization; however, sex differences in coronary revascularization vary by type of therapy. [ABSTRACT FROM AUTHOR]

Context: Many studies indicate that women are less likely than men to undergo cardiac procedures after an acute myocardial infarction (AMI), raising concerns of sexual bias in clinical care. However, no data exist regarding the relationship between patient sex, physician sex, and use of cardiac procedures.Objective: To determine whether sex differences in cardiac catheterization after AMI were greater when patients were treated by male attending physicians compared with female attending physicians.Design, Setting, and Patients: Analysis of data from the Cooperative Cardiovascular Project, a retrospective medical record review. A total of 104 >231 Medicare fee-for-service beneficiaries who were hospitalized in US acute care hospitals for an AMI between January 1994 and February 1995.Main Outcome Measure: Use of cardiac catheterization within 60 days of admission, compared between the 4 groups of patient sex-physician sex combinations.Results: Women underwent fewer cardiac catheterizations than men when treated by either male physicians (38.6% vs 50.8%; P =.001) or female physicians (34.8% vs 45.8%; P =.001). Sex differences in procedure use were not greater when a patient and physician were of different sexes (P for interaction =.85). After potential confounders in multivariable analysis were accounted for, women were less likely to undergo cardiac catheterization (risk ratio, 0.90 [95% confidence interval (CI), 0.88-0.92]), regardless of the treating physician's sex. Patients treated by male physicians were more likely to undergo cardiac catheterization (risk ratio, 1.06 [95%CI, 1.02-1.10]) than those treated by female physicians, regardless of patient sex.Conclusions: Women who have had an AMI undergo a cardiac catheterization less often than men, whether treated by a male or female physician. These results suggest that factors other than sexual bias by male physicians toward women account for sex differences in cardiac procedure use. [ABSTRACT FROM AUTHOR]

Context: Patients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions.Objective: To assess the predictive value of classification schemes that estimate stroke risk in patients with AF.Design, Setting, and Patients: Two existing classification schemes were combined into a new stroke-risk scheme, the CHADS( 2) index, and all 3 classification schemes were validated. The CHADS( 2) was formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and by assigning 2 points for history of stroke or transient ischemic attack. Data from peer review organizations representing 7 states were used to assemble a National Registry of AF (NRAF) consisting of 1733 Medicare beneficiaries aged 65 to 95 years who had nonrheumatic AF and were not prescribed warfarin at hospital discharge.Main Outcome Measure: Hospitalization for ischemic stroke, determined by Medicare claims data.Results: During 2121 patient-years of follow-up, 94 patients were readmitted to the hospital for ischemic stroke (stroke rate, 4.4 per 100 patient-years). As indicated by a c statistic greater than 0.5, the 2 existing classification schemes predicted stroke better than chance: c of 0.68 (95% confidence interval [CI], 0.65-0.71) for the scheme developed by the Atrial Fibrillation Investigators (AFI) and c of 0.74 (95% CI, 0.71-0.76) for the Stroke Prevention in Atrial Fibrillation (SPAF) III scheme. However, with a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS( 2) index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS( 2) score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6.Conclusion: The 2 existing classification schemes and especially a new stroke risk index, CHADS( 2), can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy. [ABSTRACT FROM AUTHOR]

Context: Based on evidence that beta-blockers can reduce mortality in patients with acute myocardial infarction (AMI), many hospitals have initiated performance improvement efforts to increase prescription of beta-blockers at discharge. Determination of the factors associated with such improvements may provide guidance to hospitals that have been less successful in increasing beta-blocker use.Objectives: To identify factors that may influence the success of improvement efforts to increase beta-blocker use after AMI and to develop a taxonomy for classifying such efforts.Design, Setting, and Participants: Qualitative study in which data were gathered from in-depth interviews conducted in March-June 2000 with 45 key physician, nursing, quality management, and administrative participants at 8 US hospitals chosen to represent a range of hospital sizes, geographic regions, and changes in beta-blocker use rates between October 1996 and September 1999.Main Outcome Measures: Initiatives, strategies, and approaches to improve care for patients with AMI.Results: The interviews revealed 6 broad factors that characterized hospital-based improvement efforts: goals of the efforts, administrative support, support among clinicians, design and implementation of improvement initiatives, use of data, and modifying variables. Hospitals with greater improvements in beta-blocker use over time demonstrated 4 characteristics not found in hospitals with less or no improvement: shared goals for improvement, substantial administrative support, strong physician leadership advocating beta-blocker use, and use of credible data feedback.Conclusions: This study provides a context for understanding efforts to improve care in the hospital setting by describing a taxonomy for classifying and evaluating such efforts. In addition, the study suggests possible elements of successful efforts to increase beta-blocker use for patients with AMI. [ABSTRACT FROM AUTHOR]

We examine whether Medicare patients with acute myocardial infarction (AMI) admitted to one of HCIA-Mercer's '100 top hospitals' received better care or had better outcomes than patients treated in other hospitals. Among four hospital peer groups, the top 100 hospitals had similar thirty-day mortality and use of aspirin, beta-blockers, and reperfusion compared with their peers, but lower lengths-of-stay and in-hospital costs, with similar or lower readmission rates. Our findings suggest that the 100 Top Hospitals study may be better suited for identifying hospitals with higher performance on financial and operating measures than superior clinical performance in treating elderly AMI patients. However, there was no evidence that quality was sacrificed for increased financial efficiency among the top 100 hospitals. [ABSTRACT FROM AUTHOR]

Background: Despite the evidence supporting the importance of early beta-blocker therapy, this intervention has received little attention as an indicator of quality of care.Objectives: To determine how often beta-blockers are administered as early treatment of acute myocardial infarction in patients 65 years of age or older, to identify predictors of the decision to use beta-blockers, and to evaluate the association between the early use of beta-blockers and in-hospital mortality.Design: Observational study.Setting: Nongovernment, acute care hospitals in the United States.Patients: Medicare beneficiaries who were 65 years of age or older, were hospitalized with an acute myocardial infarction in 1994 and 1995, and did not have a contraindication to beta-blocker therapy.Measurements: Medical chart review to obtain information about the use of beta-blockers, contraindications to these drugs, patient demographics, and clinical factors.Results: Of the 58 165 patients (from a total of 4414 hospitals), 28 256 (49%) received early beta-blocker therapy. Patients with the highest risk for in-hospital death were the least likely to receive therapy. Patients who received beta-blockers had a lower in-hospital mortality rate than patients who did not receive beta-blockers (odds ratio, 0.81 [95% CI, 0.75 to 0.87]), even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the two groups.Conclusions: Early beta-blocker therapy was not used for 51% of elderly patients who were hospitalized with an acute myocardial infarction and did not have a contraindication to this therapy. Increasing the early use of beta-blockers for these patients would provide an excellent opportunity to improve their care and outcomes. [ABSTRACT FROM AUTHOR]

Long-term gastrostomy is a predictable intervention to ameliorate the effects of feeding and swallowing difficulties among children with severe spastic cerebral palsy. The evidence evaluating the efficacy and implications of the available gastrostomy devices in common use has focused primarily on the operative phase, ignoring the long-term effects that may be critical from a nurse's or family caregiver's point of view. In this study, the authors describe a sample of children with gastrostomy, comparing skin-level and tube devices on measures of nutritional outcome, complications, and caregiver satisfaction. In contrast to manufacturer's claims about the superiority of skin-level devices, the results presented here reveal few differences between the devices. The authors conclude, therefore, that device selection should be determined by individualized comprehensive assessment of the child and family circumstances. [ABSTRACT FROM AUTHOR]

Context: Despite the importance of beta-blockers for secondary prevention after acute myocardial infarction (AMI), several studies have suggested that they are substantially underutilized, particularly in older patients.Objectives: To describe the contemporary national pattern of beta-blocker prescription at hospital discharge among patients aged 65 years or older with an AMI, to identify the most important predictors of the prescribed use of beta-blockers at discharge, and to determine the independent association between beta-blockers at discharge and mortality in clinical practice.Design: Retrospective cohort study using data created from medical charts and administrative files.Setting: Acute care nongovernmental hospitals in the United States.Patients: National cohort of 115015 eligible patients aged 65 years or older who survived hospitalization with a confirmed AMI in 1994 or 1995.Main Outcome Measures: Blocker as a discharge medication and mortality in the year after discharge.Results: Among the 45308 patients without contraindications to beta-blockers, 22665 (50.0%) had a beta-blocker as a discharge medication. There was significant variation by state, ranging from 30.3% to 77.1 %. Of the 36795 patients who were not receiving beta-blocker therapy on admission, 16006 (43.5%) had therapy initiated on or before discharge. Demographic and clinical variables explained relatively little of the variation in the initiation of beta-blocker therapy. The prescribed use of calcium channel blockers at discharge had a strong negative association with the use of beta-blockers (odds ratio [OR] of beta-blocker use, 0.25; 95% confidence interval [CI], 0.24-0.26). The New England region had significantly higher use of beta-blocker therapy than the rest of the country. Compared with cardiologists, internists had similar rates (OR, 0.94; 95% CI, 0.90-1.00) and general and family practice physicians had lower rates (OR, 0.78; 95% CI, 0.73-0.83). After adjusting for potential confounders, beta-blockers were associated with a 14% lower risk of mortality at 1 year after discharge. The association with lower mortality was present in subgroups stratified by age, sex, and left ventricular ejection fraction.Conclusions: Many ideal patients for beta-blocker therapy are not prescribed these drugs at discharge following AMI. The clinical and demographic characteristics of the patients do not explain much of the variation in the treatment pattern. Geographic factors and physician specialty are independently associated with the decision to use beta-blockers. Elderly patients who are prescribed beta-blockers at discharge have a better survival rate, consistent with the findings of randomized controlled trials of younger and lower-risk populations. [ABSTRACT FROM AUTHOR]

Objectives: To determine how often aspirin was prescribed as a discharge medication to eligible patients 65 years of age and older who were hospitalized with an acute myocardial infarction; to identify patient characteristics associated with the decision to use aspirin; and to evaluate the association between prescription of aspirin at discharge and 6-month survival.Design: Observational study.Setting: All 352 nongovernment, acute care hospitals in Alabama, Connecticut, Iowa, and Wisconsin.Patients: 5490 consecutive Medicare beneficiaries who survived an acute myocardial infarction, were hospitalized between June 1992 and February 1993, and did not have a contraindication to aspirin.Measurements: Medical charts were reviewed to obtain information on the prescription of aspirin at discharge, contraindications, patient demographic characteristics, and clinical factors.Results: 4149 patients (76%) were prescribed aspirin at hospital discharge. In a multivariable analysis, an increased prescribed use of aspirin at discharge was correlated with several indicators of better overall health status (better left ventricular ejection fraction, absence of diabetes, shorter length of hospital stay, higher albumin level, and discharge to the patient's home). The prescribed use of aspirin at discharge was also associated with several specific patterns of care, including the use of cardiac procedures, beta-blocker therapy at discharge, and aspirin during the hospitalization. The prescribed use of aspirin at discharge was associated with a lower mortality rate 6 months after discharge compared with no prescribed aspirin (odds ratio, 0.77; 95% CI, 0.61 to 0.98), even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the two groups.Conclusions: Aspirin was not prescribed at discharge to 24% of elderly patients who were hospitalized with an acute myocardial infarction and did not have a contraindication to aspirin. Several patient characteristics were associated with a higher risk for not being prescribed aspirin. Increasing the prescription of aspirin for these patients may provide an excellent opportunity to improve their care. [ABSTRACT FROM AUTHOR]

QUESTIONS: How do older adolescents with cerebral palsy who are at the transition stage to adult life define success? What are the factors related to success?DesignExploratory qualitative study.SettingSouthwestern Ontario, Canada.Participants10 adolescents with cerebral palsy aged 18-20 years (mean age 19 y, 70% women). 5 adolescents were nearing the end of high school, 2 had recently graduated, and 3 had just begun university or college. 2 adolescents were non-ambulatory. Participants had to have the cognitive and communicative ability to understand abstract questions and articulate thoughts.Methods2 hour semistructured interviews were held with each participant. Questions were designed to obtain the participant's view of the meaning of success in life and the factors that helped or hindered success. Interviews were audiotaped and transcribed verbatim. Transcripts were coded according to a coding scheme; a subset of the transcripts was coded separately by 2 individuals to ensure validity. A constant comparative method was used to derive emergent themes. 4 participants attended a focus group to ensure validity of the themes.Main findingsThe emergent psychosocial themes dealt with what success meant and 3 key factors related to success: being believed in by others, believing in yourself, and being accepted by others.Participants defined success as being happy in life and described happiness as a characteristic of successful role models. Happiness was associated with meeting personal goals, feeling fulfilled, and enjoying what one does in life.Being believed in by others was a key factor in being successful in life. Participants felt that faith and support given by others provided a sense of competence for reaching goals. Participants expressed that 'barrier people' who lacked belief in people with disabilities (a 'limiting attitude') limited their opportunities. Participants coped with those having limiting attitudes by having the determination to succeed and prove them wrong.Believing in yourself referred to having a sense of self efficacy and positive thinking. Being believed in by others could increase self confidence and the sense of self efficacy.Being accepted by others gave participants a sense of belonging, which was part of feeling success in life. Participants expressed the importance of having relationships and belonging to groups of people with and without disabilities.ConclusionsOlder adolescents with cerebral palsy who were facing the transition to adult life perceived success to mean being happy in life. Factors related to success were being believed in by others, believing in yourself, and being accepted by others. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We sought to recommend an approach for minimizing preventable delays in door-to-balloon time on the basis of experiences in top-performing hospitals nationally. BACKGROUND: Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity; however, door-to-balloon times often exceed the 90-min guideline set forth by the American College of Cardiology (ACC) and the American Heart Association (AHA). METHODS: We conducted a qualitative study using in-depth interviews (n = 122) of hospital staff at hospitals (n = 11) selected as top performers based on data from the National Registry of Myocardial Infarction from January 2001 to December 2002. We used the constant comparative method of qualitative data analysis to synthesize best practices across the hospitals. RESULTS: Top performers were those with median door-to-balloon times of < or =90 min for their most recent 50 PCI cases through December 2002 and the greatest improvement in median door-to-balloon times during the preceding four-year period 1999 to 2002. Several critical innovations are described, including use of pre-hospital electrocardiograms (ECGs) to activate the catheterization laboratory, allowing emergency physicians to activate the catheterization laboratory, and substantial interdisciplinary collaboration throughout the process. In the ideal approach, door-to-balloon time is 60 min for patients transported by paramedics with a pre-hospital ECG and 80 min for patients who arrive without paramedic transport and a pre-hospital ECG. CONCLUSIONS: Hospitals can achieve the recommended ACC/AHA guidelines for door-to-balloon time with specific process design efforts. However, the recommended best practices involve extensive interdisciplinary collaboration and will likely require explicit strategies for overcoming barriers to organizational change. [ABSTRACT FROM AUTHOR]

We reviewed data from 147 patients followed at a Veterans Administration hospital regarding management of hypercholesterolemia. Less than one half of patients with lipid analysis who met Adult Treatment Panel II/National Education Cholesterol Program guideline criteria for initiation of medical therapy received lipid-lowering agents in 1 year of follow-up. [ABSTRACT FROM AUTHOR]

Objectives: We determined the effect of a targeted education and support intervention on the rate of readmission or death and hospital costs in patients with heart failure (HF).Background: Disease management programs for patients with HF including medical components may reduce readmissions by 40% or more, but the value of an intervention focused on education and support is not known.Methods: We conducted a prospective, randomized trial of a formal education and support intervention on one-year readmission or mortality and costs of care for patients hospitalized with HF.Results: Among the 88 patients (44 intervention and 44 control) in the study, 25 patients (56.8%) in the intervention group and 36 patients (81.8%) in the control group had at least one readmission or died during one-year follow-up (relative risk = 0.69, 95% confidence interval [CI]: 0.52, 0.92; p = 0.01). The intervention was associated with a 39% decrease in the total number of readmissions (intervention group: 49 readmissions; control group: 80 readmissions, p = 0.06). After adjusting for clinical and demographic characteristics, the intervention group had a significantly lower risk of readmission compared with the control group (hazard ratio = 0.56, 95% CI: 0.32, 0.96; p = 0.03) and hospital readmission costs of $7,515 less per patient.Conclusions: A formal education and support intervention substantially reduced adverse clinical outcomes and costs for patients with HF. [ABSTRACT FROM AUTHOR]