Usefulness of a Nurse-Led Program of Care for Management of Patients with Chronic Heart Failure

Abstract

Departmental sources Background: The aims of the present study were to determine whether a nurse-led program of care can improve medication adherence, quality of life (QoL), rates of rehospitalization, and all-cause mortality for chronic heart failure (CHF) patients. Material/Methods: CHF patients were randomly assigned into either a control group or an intervention group. At 12 weeks, patients were followed up to evaluate the rate of medication adherence, QoL (as assessed by SF-12 physical and mental component score [PCS and MCS]), rehospitalization, and all-cause mortality. Results: We recruited 152 patients. No significant differences in demographics, comorbidities, CHF severity, or etiology at baseline were observed. At discharge, no significant differences in medications prescription, PCS (46 vs. 45), or MCS (55 vs. 56) were observed. However, at 12-week follow-up, compared to the control group, patients in the intervention group were more likely to keep on medications therapy, with a significantly higher use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker [73.8% vs. 59.7%], beta-blocker (62.5% vs. 51.4%), and aldosterone receptor antagonist (60% vs. 54.2%). Both PCS (35 vs. 40) and MCS (42 vs. 49) were also significantly lower in the control group versus the intervention groups (P<0.05). Patients in the control group had higher incident rate of rehospitalization (8.0% vs. 5.2% per person-week) than in the intervention group, with an incident rate ratio of 1.54 (95% confidence interval [CI]: 1.06-2.23). Conclusions: A nurse-led discharge program of care can be a cost-effective and feasible approach for management of CHF patients in China.

Effect of Nurse-Led Program in Coronary Heart Diseases Patients: A Systematic Review

“…Healthy living behavior and adherence to self-care could be improved by conducting nurse-led program intervention. The results of this review are in line with other studies in which the nurse-led program can improve health behavior in the form of medication adherence to patients suffering from chronic heart failure [22] and health-promoting behavior in patients with metabolic syndrome [23]. Diet regulating behavior and increased exercise were also found to be better [24].…”

Nurse‐led ambulatory care supported by non‐invasive haemodynamic assessment after acute heart failure decompensation

“…[18][19][20][21] In a prospective, multicentre randomized Nurse-led ambulatory care in heart failure controlled WHICH trial, 18 it was shown that even home-based nurse intervention provided benefits for HF patients, such as reductions in the duration of hospitalization and lower healthcare costs. Additionally, You et al 19 demonstrated the positive effects of a telephone-based, nurse-led postdischarge programme, which improved the adherence of patients to guideline-directed medication therapy for 12 weeks, their quality of life, and rate of rehospitalization. The holistic perception of the clinical state of patients by experienced HF nurses and personal relationships with patients and their caregivers may provide even better opportunities to deliver education tailored to the needs of individual patients to a greater extent than general practitioners and specialists.…”

“…In a prospective, multicentre randomized controlled WHICH trial, 18 it was shown that even home‐based nurse intervention provided benefits for HF patients, such as reductions in the duration of hospitalization and lower healthcare costs. Additionally, You et al 19 . demonstrated the positive effects of a telephone‐based, nurse‐led post‐discharge programme, which improved the adherence of patients to guideline‐directed medication therapy for 12 weeks, their quality of life, and rate of rehospitalization.…”

“…Nursing interventions, such as scheduled outpatient follow‐up appointments, self‐monitoring education, and remote telemonitoring, have been shown to improve the prognosis of patients and reduce rehospitalization rates in HF patients 18–21 . In a prospective, multicentre randomized controlled WHICH trial, 18 it was shown that even home‐based nurse intervention provided benefits for HF patients, such as reductions in the duration of hospitalization and lower healthcare costs.…”

“…Nursing interventions, such as scheduled outpatient follow-up appointments, self-monitoring education, and remote telemonitoring, have been shown to improve the prognosis of patients and reduce rehospitalization rates in HF patients. [18][19][20][21] In a prospective, multicentre randomized Nurse-led ambulatory care in heart failure controlled WHICH trial, 18 it was shown that even home-based nurse intervention provided benefits for HF patients, such as reductions in the duration of hospitalization and lower healthcare costs. Additionally, You et al 19 demonstrated the positive effects of a telephone-based, nurse-led postdischarge programme, which improved the adherence of patients to guideline-directed medication therapy for 12 weeks, their quality of life, and rate of rehospitalization.…”