Left ventricular diastolic or systolic dysfunction at 3 years was associated with an increased risk of de novo heart failure or death compared with a normal echocardiogram (HR 2.07; 95% CI 1.05-4.05; P=0.035).
RCT (n=454)
Randomized
No
Does nurse-led prevention reduce de novo HF and/or all-cause mortality in cardiac inpatients without HF?
Positive initial effects of a nurse-led intervention on cardiac recovery in high-risk patients without HF may contribute to better long-term outcomes, though prevention of HF remains challenging.
Hazard Ratio: 2.07 (95% CI 1.05–4.05)
Absolute Event Rate: 36.2% vs 10.9%
p-value: p=0.035
Abstract Aims We extended follow-up of a heart failure (HF) prevention study to determine if initially positive findings of improved cardiac recovery were translated into less de novo HF and/or all-cause mortality (primary endpoint) in the longer term. Methods and results The Nurse-led Intervention for Less Chronic HF (NIL-CHF) study was a single-centre randomized trial of nurse-led prevention involving cardiac inpatients without HF. At 3 years, 454 survivors (aged 66 ± 11 years, 71% men and 68% coronary artery disease) had the following: (i) a normal echocardiogram (128 cases/28.2%), (ii) structural heart disease (196/43.2%), or (iii) left ventricular diastolic dysfunction/left ventricular systolic dysfunction (LVDD/LVSD: 130/28.6%). Outcomes were examined during median 8.3 (interquartile range 7.8–8.8) years according to these hierarchal groups and change in cardiac status from baseline to 3 years. Overall, 109 (24.0%) participants had a de novo HF admission or died while accumulating 551 cardiovascular-related admissions/3643 days of hospital stay. Progressively worse cardiac status correlated with increased hospitalizations (P 0.001). The mean rate (95% confidence interval) of cardiovascular admissions/days of hospital stay being 0.09 (0.05–0.12) admissions/0.33 (0.13–0.54) days vs. 0.27 (0.20–0.34) admissions/2.20 (1.36–3.04) days per annum for those with a normal echocardiogram vs. LVDD/LVSD at 3 years. With progressively higher event rates, the adjusted hazard ratio for a de novo HF admission and/or death associated with a structural abnormality (24.5% of cases) and LVDD/LVSD (36.2%) at 3 years was 1.57 (0.82–3.01; P = 0.173) and 2.07 (1.05–4.05; P = 0.035) compared with a normal echocardiogram (10.9%). Mortality also mirrored the direction/extent of cardiac status/trajectory. Conclusions These data suggest the positive initial effects of NIL-CHF intervention on cardiac recovery contributed to better long-term outcomes among patients at high risk of HF. However, prevention of HF remains challenging.
Chan et al. (Thu,) conducted a rct in High risk of heart failure (n=454). Nurse-led Intervention for Less Chronic HF (NIL-CHF) vs. Usual care / Normal echocardiogram was evaluated on De novo heart failure admission and/or all-cause mortality (HR 2.07, 95% CI 1.05-4.05, p=0.035). Left ventricular diastolic or systolic dysfunction at 3 years was associated with an increased risk of de novo heart failure or death compared with a normal echocardiogram (HR 2.07; 95% CI 1.05-4.05; P=0.035).