Between January 1998 and January 2000, we recruited patients
seen at the emergency department of or admitted to the Montreal
Heart Institute with a primary diagnosis of congestive heart failure.
The diagnosis required the presence of both signs (at least 1
of tachycardia, gallop rhythm, increased jugular venous pressure
[> 10 cm] or pulmonary crackles) and symptoms (at least 1 of dyspnea
at rest or minimal effort, paroxysmal nocturnal dyspnea or
orthopnea). Patients also had either radiologic confirmation of
their congestive heart failure or a known impaired left ventricular
ejection fraction (< 45%). Echocardiography was conducted to
document left ventricle function if it had not been performed
within the previous 6 months. At discharge, all consecutive eligible
patients were approached to participate in the study. In order
to maximize the generalizability of the results, exclusion criteria
were kept to a minimum: a primary diagnosis of acute myocardial
infarction, discharge to a chronic care facility, scheduled cardiac
surgery, unwillingness to sign informed consent or to attend the
outpatient clinic, participation in another research trial, or residence
in an outlying area. Eligible patients who agreed to participate
were randomly assigned to the control group or intervention
group using consecutively numbered opaque envelopes that contained
a random number generating group assignment.