What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=706). Intervention: Nurse-coordinated management (HeartNetCare-HF) vs. Usual Care. Primary outcome: Achievement of guideline-recommended target doses for ACEi/ARB (p=<0.001).

March 2, 2015Open Access

Nurse-Coordinated Collaborative Disease Management Improves the Quality of Guideline-Recommended Heart Failure Therapy, Patient-Reported Outcomes, and Left Ventricular Remodelling

Q: What are the key findings of this study?

Nurse-coordinated management significantly increased the achievement of guideline-recommended target doses for ACEi/ARB (50% vs 25%, P<0.001) and beta-blockers (39% vs 15%, P<0.001) at 18 months.

Key Result

Nurse-coordinated management significantly increased the achievement of guideline-recommended target doses for ACEi/ARB (50% vs 25%, P<0.001) and beta-blockers (39% vs 15%, P<0.001) at 18 months.

Study Design

Type

Cohort (n=706)

Structured PICO

Does nurse-coordinated management improve guideline-recommended heart failure therapy, patient-reported outcomes, and left ventricular remodelling in patients hospitalized for decompensated HF with LVEF ≤40%?

Population

706 patients hospitalized for decompensated heart failure with LVEF ≤40% before discharge, surviving >18 months

Intervention

Nurse-coordinated management (HeartNetCare-HF)

Comparator

Usual Care

Outcome

Prescription rates and dosages of ACEi/ARB, beta-blockers, and MRA, and concomitant changes of symptoms, echocardiographic parameters of left ventricular function and morphology, and SF-36 Health Survey results at 18 monthssurrogate

Nurse-coordinated disease management significantly improves adherence to guideline-directed medical therapy target doses, left ventricular ejection fraction, and patient-reported quality of life in patients with heart failure with reduced ejection fraction.

Main Result

Absolute Event Rate: 50% vs 25%

p-value: p=<0.001

Abstract

BACKGROUND: Heart failure (HF) pharmacotherapy is often not prescribed according to guidelines. This longitudinal study investigated prescription rates and dosages of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers, and mineralocorticoid receptor antagonists (MRA), and concomitant changes of symptoms, echocardiographic parameters of left ventricular (LV) function and morphology and results of the Short Form-36 (SF-36) Health Survey in participants of the Interdisciplinary Network Heart Failure (INH) programme. METHODS AND RESULTS: The INH study evaluated a nurse-coordinated management, HeartNetCare-HF(TM) (HNC), against Usual Care (UC) in patients hospitalized for decompensated HF [LV ejection fraction (LVEF) ≤40% before discharge). A total of 706 subjects surviving >18 months (363 UC, 343 HNC) were examined 6-monthly. At baseline, 92% received ACEi/ARB, (HNC/UC 91/93%, P = 0.28), 86% received beta-blockers (86/86%, P = 0.83), and 44% received MRA (42/47%, P = 0.07). After 18 months, beta-blocker use had increased only in HNC (+7.6%, P < 0.001). Guideline-recommended target doses were achieved more frequently in HNC for ACEi/ARB (HNC/UC: 50/25%, P < 0.001) and beta-blockers (39/15%, P < 0.001). The following variables were more improved and/or better in subjects undergoing HNC compared with UC: LVEF (47 ± 12 vs. 44 ± 12%, P = 0.004, change +17/+14%, P = 0.010), LV end-diastolic diameter (59 ± 9 vs. 61 ± 9.6 mm, P = 0.024, change -2.3/-1.4 mm, P = 0.13), New York Heart Association class (1.9 ± 0.7 vs. 2.1 ± 0.7, P = 0.001, change -0.44/-0.25, P = 0.002) and SF-36 physical component summary score (41.6 ± 11.2 vs. 38.5 ± 11.8, P = 0.004, change +3.3 vs. +1.1 score points, P < 0.02). CONCLUSIONS: Prescription rates and dosages of ACEi/ARB and beta-blockers improved more in HNC than UC patients. Concomitantly, participation in HNC was associated with significantly better clinical outcomes and more favourable echocardiographic changes after 18 months.