Trial reportBMC cardiovascular disorders2026
Prognostic factors related to all-cause mortality in very long-term follow-up of patients with heart failure: the REMADHE trial extended analysis.
Trial report in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00505050 (A Long-Term Prospective Randomized Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients - The REMADHE Study), which is not on this map. Not yet cited in PubMed.
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A Long-Term Prospective Randomized Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients - The REMADHE Study
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11 authors.
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Abstract
backgroundDisease management programs (DMP) have reduced hospitalizations and improved quality of life in heart failure (HF). However, prognostic factors and survival in very long-term follow-up (> 20 years) have not been reported.
aimsTo evaluate the long-term effects of a disease management program (DMP) on heart failure outcomes and to identify prognostic predictors of all-cause mortality in patients with HF followed for up to 23.6 years.
methodsThe REMADHE trial (NCT00505050, 2007-07-20) was a prospective, single-center, randomized trial (n = 412) comparing DMP versus usual care (C) with initial follow-up of 2.47 years. This extended analysis followed patients for 23.6 years to identify prognostic predictors of all-cause mortality.
resultsThe all-cause mortality rate was 88.3%. HF was the first cause of death followed by sudden death. Mortality was higher in the first 6-year follow-up. The predictive variables in multivariate analysis associated with mortality were age > 52 years (P = 0.015), Chagas etiology (P = 0.010), LVEF < 45% (P = 0.008), digoxin use (P = 0.002), NYHA IV (P = 0.01), blood urea nitrogen (BUN) (P = 0.03), and lymphopenia (P = 0.005). In very long-term follow-up, DMP did not affect mortality in patients under guideline-directed medical therapy (GDMT). HF as a cause of death was more frequent in the C group (41.0% vs. 33.3% in the DMP group; P < 0.02).
conclusionsDMP was not effective in reducing very long-term mortality; however, causes of death differed between groups, with more HF-related deaths in controls. Our findings that age, LVEF, Chagas' disease, NYHA, renal function, lymphocytes, and digoxin use were associated with poor prognosis could influence future strategies to improve HF management.
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