Why the study?
To prevent early hospital readmissions in heart failure, coordinated discharge planning and individualized therapeutic approaches are recommended.
Does nurse-led ambulatory care supported by non-invasive haemodynamic assessment improve functional status and well-being in patients post-acute heart failure decompensation?
Does nurse-led ambulatory care supported by non-invasive haemodynamic assessment improve functional status and well-being in patients post-acute heart failure decompensation?
A 1-month nurse-led ambulatory care program using non-invasive hemodynamic assessment significantly improved functional status and well-being in patients recently hospitalized for acute heart failure.
Answers are grounded in this paper and cite their sources.
Nurse-led ambulatory care was associated with better well-being post-HF decompensation; hypothesis-generating and requires randomized confirmation before practice change.
Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended. AIMS: We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non-invasive haemodynamic assessment, on the functional status, well-being, and haemodynamic status of patients post-acute HF decompensation. METHODS AND RESULTS: This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non-invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow-up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class (P = 0.013) and sense of well-being as evaluated by a visual analogue score (P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%). CONCLUSIONS: The proposed model of nurse-led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well-being, and (iii) high rate of pharmacotherapy modifications.
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Krzesiński et al. (2021) studied this question.
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