Lack of improvement of clinical outcomes by a low-cost, hospital-based heart failure management programme.

Cardiology Unit, Cardiopulmonary Science Department, S. Maria della Misericordia Hospital, Udine, Italy.
Journal of Cardiovascular Medicine (Impact Factor: 1.41). 08/2006; 7(8):614-22. DOI: 10.2459/01.JCM.0000237910.34000.58
Source: PubMed

ABSTRACT Heart failure (HF) is a major health problem resulting in a high financial burden for the healthcare system. Many previous HF management programmes reduced adverse clinical outcomes and costs, but they usually involved several professional figures as well as huge investments, requiring resources and budgets not often available in our healthcare system. We evaluated the effects of our HF management programme, which included patient education and regular outpatient contact with the HF team, on re-hospitalisation and death, optimising the few resources already available at our hospital.
Two hundred consecutive patients admitted to the internal medicine department with a diagnosis of HF were randomised to the intervention group (nurse-led education programme, facilitated telephone communication and follow-up visits with an internist at 15 days, 1 and 6 months) or to the usual care group (follow-up by their primary care physician). The primary endpoints were all-cause readmissions and all-cause deaths during the 6-month post-discharge period.
There were 81 all-cause hospital readmissions in the intervention group and 82 in the control group (P = NS). Fourteen patients (14%) in the intervention group and eight patients (8%) in the control group died during the study period (P = NS). Unplanned outpatient visits were less frequent in the intervention group than in the control group (39 [28%] versus 99 [72%], P < 0.001).
The present low-cost HF management programme reduced unplanned outpatient visits but proved ineffective in reducing subsequent readmissions and in improving clinical status. More intense follow-up monitoring and more resources are needed to achieve better results.


Available from: Gaetano Nucifora, Jul 12, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To identify the main contextual factors and processes that influence patients' self-care of heart failure (HF). A systematic review was conducted using qualitative meta-synthesis. Ten databases were searched until March 19, 2012. Of the 1421 papers identified by the systematic search, 45 studies were included in this meta-synthesis. To be included studies had to contain a qualitative research component, data pertaining to self-care of HF from adults (18+) and be published as full papers/theses from 1995 onwards. These studies involved: 1,398 patients (mean age 65.9 years), 180 caregivers and 63 health professionals. Six main types of contextual factors were found to influence HF self-care in the studies: caregivers, social networks and social support, place, finances and financial capacity, work and occupation, and HF support groups and programs. HF self-care is influenced by contextual elements that fall outside of traditional elements of an HF self-care program. Inclusion of these elements may help to address the current concerns about poor adherence to self-management programs.
    Journal of cardiac failure 04/2014; DOI:10.1016/j.cardfail.2014.03.010 · 3.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:: Individuals with heart failure are frequently rehospitalized owing to a lack of knowledge concerning how to perform their self-care and when to inform their healthcare provider of worsening symptoms. Because there are an overwhelming number of hospital readmissions for individuals with heart failure, efforts are underway to discover how they can be supported and educated during their hospitalization and subsequently followed by a nurse after discharge for continued education and support. PURPOSE:: The purpose of this integrative review was to critically examine the interventions, quality of life, and readmission rates of individuals with heart failure who are enrolled in a transitional care program. The second aim was to examine the cost-effectiveness of nurse-led transitional care programs. CONCLUSIONS:: The results of this integrative review (n = 20) showed that transitional care programs for individuals with heart failure can increase a patient's quality of life and decrease the number of readmissions and the overall cost of care. The types of interventions that were most successful in decreasing readmissions used home visits alone or in combination with telephone calls. There is a need for nurse researchers to address gaps in transitional care for heart failure patients by performing studies with larger randomized clinical trials and measuring outcomes such as readmissions at regular intervals over the study period. CLINICAL IMPLICATIONS:: The Patient Protection and Affordable Care Act will change reimbursement for heart failure readmissions and presents opportunities for healthcare teams to build transitional care programs for patients with conditions such as heart failure. This integrative review can be used to determine effective intervention strategies for transitional care programs and highlights the gaps in research. Healthcare teams that use these programs within their practice may increase continuity of care and quality of life and decrease readmissions and healthcare costs for individuals with heart failure.
    The Journal of cardiovascular nursing 01/2013; DOI:10.1097/JCN.0b013e31827db560 · 1.81 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Disease management interventions for heart failure (HF) are inconsistent and very seldom incorporate the views and needs of patients and their caregivers into intervention design. To improve intervention effectiveness and consistency, a systematic review identified 49 studies which examined the views and needs of patients with HF and their caregivers about the nature and determinants of effective HF self-care. The findings identify key drivers of effective self-care, such as the capacity of patients to successfully integrate self-care practices with their preferred normal daily life patterns and recognise and respond to HF symptoms in a timely manner. Future interventions for HF self-care must involve family members throughout the intervention and harness patients' normal daily routines.
    Heart (British Cardiac Society) 02/2014; 100(9). DOI:10.1136/heartjnl-2013-304852 · 6.02 Impact Factor