Key result
An onsite heart failure service increased the proportion of older care home residents receiving optimal doses of ACE inhibitors and beta-blockers to 21% compared to 0% with routine care, though this difference was not statistically significant (p=0.250).
Why the study?
Does an onsite heart failure service improve the optimum prescription of ACE inhibitors and beta-blockers in older long-term care residents with LVSD?
RCT (n=28)
Open-label, blinded end point (PROBE design)
Stratified blocks according to NYHA classification and by care home
Yes
Does an onsite heart failure service improve the optimum prescription of ACE inhibitors and beta-blockers in older long-term care residents with LVSD?
An onsite heart failure service for older long-term care residents with LVSD is feasible and shows a trend toward improved evidence-based medication prescription without adversely affecting quality of life.
Answers are grounded in this paper and cite their sources.
May improve optimal ACE inhibitor/beta-blocker dosing in care home residents; extends feasibility data but leaves efficacy open for larger trials.
BACKGROUND: Many older people in long-term care do not receive evidence-based diagnosis or management for heart failure; it is not known whether this can be achieved for this population. We initiated an onsite heart failure service, compared with 'usual care' with the aim of establishing the feasibility of accurate diagnosis and appropriate management. METHODS: A pilot randomised controlled trial which randomised residents from 33 care facilities in North-East England with left ventricular systolic dysfunction (LVSD) to usual care or an onsite heart failure service. The primary outcome was the optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists at 6 months. RESULTS: Of 399 echocardiographically-screened residents aged 65-100 years, 30 subjects with LVSD were eligible; 28 (93%) consented and were randomised (HF service: 16; routine care: 12). Groups were similar at baseline; six month follow-up was completed for 25 patients (89%); 3 (11%) patients died. Results for the primary outcome were not statistically significant but there was a consistent pattern of increased drug use and titration to optimum dose in the intervention group (21% compared to 0% receiving routine care, p=0.250). Hospitalisation rates, quality of life and mortality at 6 months were similar between groups. CONCLUSIONS: This study demonstrated the feasibility of an on-site heart failure service for older long-term care populations. Optimisation of medication appeared possible without adversely affecting quality of life; this questions clinicians' concerns about adverse effects in this group. This has international implications for managing such patients. These methods should be replicated in a large-scale study to quantify the scale of benefit. TRIAL REGISTRATION: ISRCTN19781227 http://www.controlled-trials.com/ISRCTN19781227
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Hancock et al. (2012) conducted an RCT in Heart failure with left ventricular systolic dysfunction (LVSD) (n=28). Onsite heart failure service vs. Routine GP-led care was evaluated on Optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists at 6 months (p=0.250). An onsite heart failure service increased the proportion of older care home residents receiving optimal doses of ACE inhibitors and beta-blockers to 21% compared to 0% with routine care, though this difference was not statistically significant (p=0.250).
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