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The authors discuss that improved prognosis in heart failure is likely multifactorial, involving both better medical treatments and structured care programs like nurse-led clinics.
We thank Strömberg and Dahlström for highlighting the structured clinical care programmes often used in Swedish hospitals. In our discussion, we clearly point out that we do not know why the prognosis for patients hospitalised for heart failure has improved.1 We discuss different possibilities and it is very likely that improved medical treatments of hypertension, ischaemic heart disease and heart failure, which have been demonstrated in big outcome studies, is of great importance for the beneficial results. We also discuss how to provide these treatments in a clinical setting. The evidence for benefit from special care programmes of patients with heart failure is limited but it is reasonable to believe that an organised treatment regimen is favourable as this care will help to disseminate evidence-based treatments. We referred to home-based care because it shows one extreme possibility.2 More recent findings from Sweden with a limited number of patients support the value of nurse-led clinics.3 Nurse-led clinics are also recommended in the ESC guidelines.4 However, as discussed elsewhere, we do not know why structured care may be successful.5 The content of the components of structured care would be important to assess for our understanding of the importance of this type of care.
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Maria Schaufelberger (2004) studied this question.
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