Impact of a Nurse-Led Heart Failure Program on All-Cause Mortality

BACKGROUND: Nurse-led heart failure programs (HFPs) have been shown to reduce readmissions and improve medication adherence rates. However, their impact on survival is not well demonstrated. OBJECTIVE: The purpose of this study was to evaluate the impact of a nurse-led HFP on all-cause mortality. METHODS: This retrospective review included 413 consecutive patients who were admitted with heart failure exacerbations in 2008 and 2009. All patients were invited to attend a nurse-led HFP; 199 (48%) patients agreed and were compared with the 214 (52%) who chose usual care. Patients were followed for all-cause mortality, which was confirmed by the national death index. Independent predictors of outcomes were identified using multivariable Cox regression. RESULTS: Patients followed in the HFP were younger, more often men with lower ejection fraction, blood urea nitrogen, and systolic blood pressure. After a median follow-up of 15 months (range, 6-30 months), a total of 55 patients died: 14 in the HFP group (7%) compared with 41 patients (19%) in the usual care group. Participation in the HFP was independently associated with reduction in all-cause mortality (hazard ratio, 0.4; 95% confidence interval, 0.2-0.8; P = .008). CONCLUSIONS: Our nurse-led HFP was independently associated with improved survival among patients with decompensated heart failure. Further research is required to confirm this finding.