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Ochsner J. 1999 Apr;1(2):63-6.

The emergence of a dynamic intervention paradigm in heart failure.

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  • 1Ochsner Cardiomyopathy and Heart Transplant Center.


Traditionally, the heart failure management model has focused on crisis intervention, which allows the disease syndrome to progress to a point that requires emergent care followed by a cycle of prolonged and repeated hospitalizations (such contacts between the patient and care providers occur at times when the heart failure syndrome has deteriorated dangerously, and are only concerned with resolving the immediate crisis). Over time this approach of emergent care results in a marked decline in the patient's quality of life and creates a "revolving door" effect with the combined use of emergency department and hospital inpatient resources. The alternative is to become proactive and optimize treatment before such emergencies arise. This model relies on effective continuous outpatient and home care to stabilize the chronic condition and avoid hospital admissions. These concepts have led to the development of a new model or paradigm of outpatient strategies that have resulted in the creation of specialized heart failure disease management centers. This article discusses the economic and epidemiological forces that are driving this shift in our treatment focus and evaluates strategies that strike an optimum balance between cost containment and quality.

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