Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse-led heart failure clinics. A meta-regression analysis

Abstract

Objectives: To determine whether a hierarchy of effectiveness exists with respect to complexity of published protocols of heart failure (HF) disease management (DM) incorporating specialist nurse-led HF clinics. Data sources and study selection: We searched MEDLINE (1966( -November 2004, the Cochrane Library, article bibliographies, and contacted experts. Inclusion criteria were random allocation of at least 100 patients, specialist HF nurses, HF clinics, and readmission as an outcome measure. Data extraction: Paired reviewers conducted quality assessment, deconstructed and categorized protocols by complexity, and extracted results for readmission, mortality, the combined endpoint of mortality and hospitalization, HF readmission, and hospital days utilized. Conclusions: HF DM with specialist nurse-led HF clinics is a promising strategy or effective alternative whose benefit may be optimized by programs with a homogeneous structure and components that are delivered with consistency.

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…The majority of these studies have been small singlecentre studies. During the past few years, a number of systematic reviews and larger randomized controlled trials (122)(123)(124)(125)(126)(127) have been performed to better estimate the effects of DMPs for HF patients on mortality and morbidity. These reviews generally found that DMPs reduce both all-cause and HF hospitalizations (122,123,(125)(126)(127).…”

“…Multidisciplinary programs involving both a doctor and a nurse specializing in HF management appear to be a consistent requirement for these programs, with the potential for further benefit from the addition of other allied health professionals such as a pharmacist (122,123,126,127,138). Combinations of in-clinic and telephone follow-ups would appear to be important with entry into the DMP as soon as possible after discharge (122,124,125). The DMP should involve education, exercise and psychosocial counselling, selfcare supportive strategy, optimization of the medication regimen and medical referrals for deterioration (122,124,125,127).…”

“…Combinations of in-clinic and telephone follow-ups would appear to be important with entry into the DMP as soon as possible after discharge (122,124,125). The DMP should involve education, exercise and psychosocial counselling, selfcare supportive strategy, optimization of the medication regimen and medical referrals for deterioration (122,124,125,127).…”

The effectiveness of nurse-led care in people with rheumatoid arthritis: A systematic review

“…Cullum et al (2005) other chronic diseases where patients require regular follow-ups and monitoring such as diabetes (Carey and Courtenay, 2007), coronary heart diseases (Page et al, 2005), heart failure (Phillips et al, 2005) and chronic obstructive pulmonary disease (Sridhar et al, 2008).…”

“…Yet there were several systematic reviews of effectiveness in primary care (Horrocks et al, 2002, Laurant et al, 2004 and other chronic diseases (Carey and Courtenay, 2007, Page et al, 2005, Phillips et al, 2005, Sridhar et al, 2008, Taylor et al, 2005.…”