Nurse Management for Heart Failure - Nurse Management for Heart Failure

Description:

The goal of the trial was to evaluate the effect of a nurse management intervention program among patients with heart failure living in minority communities.

Study Design

Study Design:

Patients Screened: 1,555
Patients Enrolled: 406
NYHA Class: Class IV 45.1%
Mean Follow Up: 18 months
Mean Patient Age: Mean age 59.4 years
Female: 46

Patient Populations:

Age ≥18 years, systolic dysfunction documented on a cardiac test, English-language or Spanish-language speakers; community-dwelling at enrollment; and current patient in a general medicine, geriatrics, or cardiology clinic or office at a participating site

Exclusions:

Medical conditions that prevented interaction with the nurse, including blindness, deafness, or cognitive impairment; medical conditions requiring individualized management that might differ from standard protocol, namely pregnancy, renal dialysis, or terminal illness; or procedures that corrected systolic dysfunction, such as heart transplantation

Primary Endpoints:

Hospitalizations during 12-month follow-up

Drug/Procedures Used:

Patients with heart failure at four hospitals in Harlem, New York were randomized to nurse management intervention (n = 203) or usual care (n = 203). Nurse management included meeting with the patients initially to educate them on heart failure and management. The nurses later contacted patients regarding medication, diet, and exercise. Nurses also coordinated care with the patient's clinician. There were three nurses who participated in the study.

Principal Findings:

The ethnicity of the population was non-Hispanic black (45.8%), Hispanic (32.5%), and non-Hispanic white (15.3%). Approximately one-quarter were Spanish-language speakers (22.7%). Only 46.1% had a high school education. New York Heart Association (NYHA) class IV was present in 45.1% of patients.

The rate of total hospitalizations by 12 months was lower in the nurse management group (n = 143 vs. n = 180, p < 0.05), although there was no difference in the frequency of at least one hospitalization (30.5% for nurse group vs. 36.5% for usual care, p = NS). Hospitalizations for heart failure were also lower in the nurse management group (n = 28 vs. n = 54, p < 0.05). Functional score was better in the nurse management group by both the SF-12 physical component score (39.9 vs. 36.3) and the Minnesota Living with Heart Failure Questionnaire score (38.6 vs. 47.3), but data were available in only 286 out of 406 patients. There was no difference in mortality (n = 22 in each group).

Interpretation:

Among patients with systolic dysfunction heart failure living in minority communities, use of the nurse management intervention program was associated with a reduction in total and heart failure hospitalizations at 1 year compared with usual care.

Prior studies have evaluated nurse intervention programs for heart failure management, including SPAN-CHF and DIAL. However, the present study focused on minority patients, the majority of whom had advance heart failure, as represented by the high rate of patients with NYHA class IV. While the findings were promising, there are several limitations of the trial, including implementation on a larger scale, as the present study was conducted with only three nurses. Also, the cost-benefit of a nurse intervention program would need to be evaluated.

References:

Sisk JE, Hebert PL, Horowitz CR, McLaughlin MA, Wang JJ, Chassin MR. Effects of nurse management on the quality of heart failure care in minority communities: a randomized trial. Ann Intern Med 2006;145:273-83.

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Diet

Keywords: Minority Groups, Language, Geriatrics, Heart Failure, Diet, Questionnaires, Hispanic Americans


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