Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failureResults from a prospective, randomised trial

Strömberg, Anna; Mårtensson, Jan; Fridlund, Bengt; Levin, L. Scott; Karlsson, Jan‐Erik; Dahlström, Ulf

doi:10.1016/s0195-668x(03)00112-x

Cited by 414 publications

(358 citation statements)

References 27 publications

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“…First, in our study, most participants saw one only caregiver, whereas in previous studies examining the role of nurses in heart failure clinics, the patient was always seen by various caregivers, including a cardiologist. [4][5][6] Second, our study group consisted of symptom-free relatives, whereas previous studies covered patients diagnosed with a cardiac or other disease. Finally, the setting of our study differed from that of previous studies.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] A study in low risk patients who had had a recent myocardial infarction demonstrated that nurse practitioners can deliver a quality of care equal to or better than conventional specialist care. 4 Improved survival and self-care behaviour was seen in patients with heart failure when they were treated by specially educated and experienced cardiac nurses. 4 The genetic counsellor in clinical genetics has a comparable role to these nurses and must, according to the European Board of Medical Genetics, be able to perform a range of tasks including providing information and facilitating the client's psychosocial adjustment to their genetic status and situation.…”

Section: Introductionmentioning

confidence: 99%

“…4 Improved survival and self-care behaviour was seen in patients with heart failure when they were treated by specially educated and experienced cardiac nurses. 4 The genetic counsellor in clinical genetics has a comparable role to these nurses and must, according to the European Board of Medical Genetics, be able to perform a range of tasks including providing information and facilitating the client's psychosocial adjustment to their genetic status and situation. 7 Skirton et al described how genetic counsellors have a significant workload associated with direct patient care and that this appears to be acceptable to patients.…”

Section: Introductionmentioning

confidence: 99%

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Follow-up care by a genetic counsellor for relatives at risk for cardiomyopathies is cost-saving and well-appreciated: a randomised comparison

et al. 2016

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Increasing numbers of patient relatives at risk of developing dilated or hypertrophic cardiomyopathy (DCM/HCM) are being identified and followed up by cardiologists according to the ACC/ESC guidelines. However, given limited healthcare resources, good-quality low-cost alternative approaches are needed. Therefore, we have compared conventional follow-up by a cardiologist with that provided at a cardiogenetic clinic (CGC) led by a genetic counsellor. Phenotype-negative first-degree relatives at risk for DCM/HCM were randomly assigned to see either a cardiologist or to attend a CGC. Uptake and resource use were recorded. For 189 participants, we evaluated quality of care experienced, patient satisfaction and perceived personal control (PPC) using validated questionnaires and estimated the average cost difference of these two modes of care. Maximum patient satisfaction scores were achieved more frequently at the CGC (86% vs 45%, Po0.01). In terms of follow-up care provided, the genetic counsellor did not perform worse than the cardiologist (95% vs 59%, Po0.01). The genetic counsellor more often enquired about the relative-at risk's health (100% vs 65%, Po0.01) and family health (97% vs 33%, Po0.01), measured blood pressure (98% vs 29%, Po0.01) and gave disease-specific information (77% vs 52%, Po0.01). Although PPC scores were equal in both groups, the average cost per patient of CGC follow-up was 25% lower. Follow-up of phenotype-negative relatives at risk for DCM/HCM at a CGC led to greater patient satisfaction and is well-appreciated at lower cost. CGC care is a good alternative to conventional cardiological follow-up for this growing group of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Follow-up care by a genetic counsellor for relatives at risk for cardiomyopathies is cost-saving and well-appreciated: a randomised comparison

et al. 2016

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“…Further, nurses are the health professionals most closely involved, according to the meta‐review of 15 meta‐analyses by Savard et al 9 A considerable number of these meta‐analyses mentioned dose titration by HF nurses. In the clinical trials included, nurses titrated ACEIs, ARBs, BBs, K, diuretics, MRAs, and digoxin,10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 assessed the dose reached,13, 14, 19, 20 and initiated treatment following a protocol 10, 12, 14, 15, 17. Hardly any similar research has been conducted in Spain.…”

Section: Introductionmentioning

confidence: 99%

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

et al. 2017

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AimsHeart failure (HF) is associated with many hospital admissions and relatively high mortality, rates decreasing with administration of beta‐blockers (BBs), angiotensin‐converting‐enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. The effect is dose dependent, suboptimal doses being common in clinical practice. The 2012 European guidelines recommend close monitoring and dose titration by HF nurses. Our main aim is to compare BB doses achieved by patients after 4 months in intervention (HF nurse‐managed) and control (cardiologist‐managed) groups. Secondary aims include comparing doses of the other aforementioned drugs achieved after 4 months, adverse events, and outcomes at 6 months in the two groups.MethodsWe have designed a multicentre (20 hospitals) non‐inferiority randomized controlled trial, including patients with new‐onset HF, left ventricular ejection fraction ≤40%, and New York Heart Association class II–III, with no contraindications to BBs. We will also conduct qualitative analysis to explore potential barriers to and facilitators of dose titration by HF nurses. In the intervention group, HF nurses will implement titration as prescribed by cardiologists, following a protocol. In controls, cardiologists will both prescribe and titrate doses. The study variables are doses of each of the drugs after 4 months relative to the target dose (%), New York Heart Association class, left ventricular ejection fraction, N‐terminal pro B‐type natriuretic peptide levels, 6 min walk distance, comorbidities, renal function, readmissions, mortality, quality of life, and psychosocial characteristics.ConclusionsThe trial seeks to assess whether titration by HF nurses of drugs recommended in practice guidelines is safe and not inferior to direct management by cardiologists. The results could have an impact on clinical practice.

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Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure<subtitle>Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)</subtitle>

Wal²,

et al. 2008

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Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups. Clinical Trial Registry http://trialregister.nl Identifier: NCT 98675639.

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Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failureResults from a prospective, randomised trial

Abstract: Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.

Cited by 414 publications

References 27 publications

Follow-up care by a genetic counsellor for relatives at risk for cardiomyopathies is cost-saving and well-appreciated: a randomised comparison

Follow-up care by a genetic counsellor for relatives at risk for cardiomyopathies is cost-saving and well-appreciated: a randomised comparison

Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol

Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure<subtitle>Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)</subtitle>

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