Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: does more equal less?. Issue 11 (7th February 2013)

• Record Type: Journal Article
• Authors: Driscoll, Andrea; Tonkin, Andrew; Stewart, Andrew; Worrall‐Carter, Linda; Thompson, David R; Riegel, Barbara; Hare, David L; Davidson, Patricia M; Mulvany, Christine; Stewart, Simon
• Is Part Of: Journal of clinical nursing. Volume 22:Issue 11/12(2013)
• Page Start: 1629
• Page End: 1638
• Publication Date: 2013-02-07
• Subjects: Nursing -- Periodicals; Clinical medicine -- Periodicals; 610.7305
• DOI: 10.1111/jocn.12073
• Languages: English
• ISSNs: 0962-1067

Abstract

<abstract abstract-type="main" id="jocn12073-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jocn12073-sec-0001" sec-type="section"> <title>Aims and objectives</title> <p>To compare the efficacy of chronic heart failure management programmes (CHF‐MPs) according to a scoring algorithm used to quantify the level of applied interventions–the Heart Failure Intervention Score (HF‐IS).</p> </sec> <sec id="jocn12073-sec-0002" sec-type="section"> <title>Background</title> <p>The overall efficacy of heart failure programmes has been proven in several meta‐analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes.</p> </sec> <sec id="jocn12073-sec-0003" sec-type="section"> <title>Design</title> <p>Prospective cohort study of patients participating in heart failure programmes.</p> </sec> <sec id="jocn12073-sec-0004" sec-type="section"> <title>Method</title> <p>Forty‐eight of 62 (77%) programmes in Australia participating in a national register of CHF‐MPs were evaluated using the HF‐IS: derived from a summed and weighted score of each intervention applied by the CHF‐MP (27 interventions overall). The CHF‐MPs were prospectively categorised as relatively low (HF‐IS < 190 – <italic>n</italic> = 39 programmes & 407 patients) or high (HF‐IS ≥ 190 – <italic>n</italic> = 9 programmes & 166 patients) in complexity. Six‐month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II–IV were prospectively examined.</p> </sec> <sec id="jocn12073-sec-0005" sec-type="section"> <title>Results</title> <p>Patients exposed to CHF‐MPs with a high HF‐IS had a lower rate of unplanned, all‐cause hospitalisation (<italic>n</italic> = 24, 14% vs. <italic>n</italic> = 102, 25%) compared with CHF‐MPs with a low HF‐IS within six months. On an adjusted basis, CHF‐MPs with a high HF‐IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event‐free longer.</p> </sec> <sec id="jocn12073-sec-0006" sec-type="section"> <title>Conclusion</title> <p>High complexity CHF‐MPs applying more evidence‐based interventions are associated with a higher event‐free survival over six months.</p> </sec> <sec id="jocn12073-sec-0007" sec-type="section"> <title>Relevance to clinical practice</title> <p>The HF‐IS is an easy‐to‐use evidence‐based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.</p> </sec> </abstract>