Nurse‐coordinated collaborative disease management improves the quality of guideline‐recommended heart failure therapy, patient‐reported outcomes, and left ventricular remodelling. (2nd March 2015)

• Record Type: Journal Article
• Authors: Güder, Gülmisal; Störk, Stefan; Gelbrich, Goetz; Brenner, Susanne; Deubner, Nikolas; Morbach, Caroline; Wallenborn, Julia; Berliner, Dominik; Ertl, Georg; Angermann, Christiane E.
• Is Part Of: European journal of heart failure. Volume 17:Number 4(2015)
• Page Start: 442
• Page End: 452
• Publication Date: 2015-03-02
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.252
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main" id="ejhf252-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhf252-sec-0001" sec-type="section"> <title>Background</title> <p id="ejhf252-para-0001">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.</p> </sec> <sec id="ejhf252-sec-0002" sec-type="section"> <title>Methods and results</title> <p id="ejhf252-para-0002">The INH study evaluated a nurse‐coordinated management, HeartNetCare‐HF<sup>TM</sup> (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%, <italic>P</italic> = 0.28), 86% received beta‐blockers (86/86%, <italic>P</italic> = 0.83), and 44% received MRA (42/47%, <italic>P</italic> = 0.07). After 18 months, beta‐blocker use had increased only in HNC (+7.6%, <italic>P</italic> < 0.001). Guideline‐recommended target doses were achieved more frequently in HNC for ACEi/ARB (HNC/UC: 50/25%, <italic>P</italic> < 0.001) and beta‐blockers (39/15%, <italic>P</italic> < 0.001). The following variables were more improved and/or better in subjects undergoing HNC compared with UC: LVEF (47 ± 12 vs. 44 ± 12%, <italic>P</italic> = 0.004, change +17/+14%, <italic>P</italic> = 0.010), LV end‐diastolic diameter (59 ± 9 vs. 61 ± 9.6 mm, <italic>P</italic> = 0.024, change −2.3/–1.4mm, <italic>P</italic> = 0.13), New York Heart Association class (1.9 ± 0.7 vs. 2.1 ± 0.7, <italic>P</italic> = 0.001, change −0.44/–0.25, <italic>P</italic> = 0.002) and SF‐36 physical component summary score (41.6 ± 11.2 vs. 38.5 ± 11.8, <italic>P</italic> = 0.004, change +3.3 vs. +1.1 score points, P < 0.02).</p> </sec> <sec id="ejhf252-sec-0003" sec-type="section"> <title>Conclusions</title> <p id="ejhf252-para-0003">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.</p> </sec> </abstract>