Nurse-led Heart Failure Clinic Research Articles

Effectiveness of advanced practice nurse-led heart failure clinics on all-cause mortality: a systematic review of quantitative evidence protocol

REVIEW OBJECTIVES/QUESTION The objective of this systematic review is to synthesize the best available evidence regarding the effectiveness of interventions delivered in advance practice nurse-led clinics on mortality in adult (19 years of age and older) patients with heart failure. The review question is: in adult patients,19 years of age and older, diagnosed with heart failure, what is the effectiveness of the interventions provided in advanced practice nurse-led heart failure clinics on all-cause mortality rates compared to usual care? INCLUSION CRITERIA Types of participants The review will consider studies that include patients who are 19 years of age or older, diagnosed with heart failure, regardless of gender, ethnicity, other co-existing health conditions, level of education, income or health insurance. Participants must have been assessed using an established classification or categorization system by a primary care provider (i.e. Advanced practice nurses, physician or cardiologist) at the beginning of the research study to determine their severity of symptoms or physical activity limitations. The New York Heart Association Functional Classification and the American Heart Association Stages of Heart Failure are two of the most widely used instruments. Types of intervention(s) The review will consider studies that evaluated evidence-based interventions delivered in Advanced practice nurses-led Heart Failure clinics compared to usual care. Usual care refers to all non-Advanced practice nurses-led Heart Failure clinics, care approaches including care provided by primary care physicians, or cardiology clinics and physician-led Heart Failure clinics. Advanced practice nurses-led Heart Failure clinics are defined as TRUNCATED AT 250 WORDS

Salt and fluid restriction is effective in patients with chronic heart failure

European and American guidelines have recommended salt and fluid restriction for patients with chronic heart failure (CHF) despite scarce scientific evidence. Therefore, we investigated the effects of salt and fluid restriction in patients with CHF. Ninety-seven stable patients in NYHA class II-IV, on optimal medication, with previous signs of fluid retention, treated with either >40 mg (NYHA III-IV) or >80 mg (NYHA II-IV) of furosemide daily were randomized to either individualized salt and fluid restriction or information given by the nurse-led heart failure clinics, e.g. be aware not to drink too much and use salt with caution, and followed for 12 weeks. Fluid was restricted to 1.5 L and salt to 5 g daily, and individualized dietary advice and support was given. The 24 h dietary recall procedure, urine collection on three consecutive days, and para-aminobenzoic acid 80 mg t.i.d. was used to assess adherence to diet and completeness of urine collection. The primary endpoint was a composite variable consisting of NYHA class, hospitalization, weight, peripheral oedema, quality of life (QoL), thirst, and diuretics. Results After 12 weeks, significantly more patients in the intervention than in the control group improved on the composite endpoint (51% vs. 16%; P < 0.001), mostly owing to improved NYHA class and leg oedema. No negative effects were seen on thirst, appetite, or QoL. Individualized salt and fluid restriction can improve signs and symptoms of CHF with no negative effects on thirst, appetite, or QoL in patients with moderate to severe CHF and previous signs of fluid retention.

16. Hospitalization and rehospitalization rates of patients in a network of nurse-led heart failure clinics

16. Hospitalization and rehospitalization rates of patients in a network of nurse-led heart failure clinics

A007 Effects of a Nurse-led Heart Failure Clinic on Patient Outcomes

A007 Effects of a Nurse-led Heart Failure Clinic on Patient Outcomes

Personalizing protocol‐driven care: the case of specialist heart failure nurses

This paper is a report of a study conducted to explore how specialist heart failure nurses negotiate treatment advice with patients, in the context of an increasing expectation that clinical staff in the National Health Services will follow guidelines in their daily work. The development of specialist nurse roles has given rise to questions about their compatibility with patient-centred care. However, research has revealed little about how specialist nurses balance clinical guidelines with traditional caring tasks. Semi-structured interviews (n = 10) were conducted with specialist heart failure nurses in northern England recruited from a heart failure specialist nursing contact list. In addition, non-participant observations were carried out on nurse-patient consultations (n = 16) in one regional nurse-led heart failure clinic. Data were collected between 2003 and 2005, and analysed using a variation of grounded theory. Heart failure nurses sought to combine traditional caring work with the wider goal of improving patient outcomes by 'personalizing' their advice to patients and presenting their heart failure as 'typical'. They accommodated protocol-driven care into their daily routines, and perceived no disjuncture between evidence-based practice and patient-centredness. However, their approach allowed little space for the exploration of each patient's own priorities about their illness. There is a need both to re-examine the appropriateness of traditional caring concepts, and to reflect on the need to incorporate patients' own values into the consultation process.

FMMP5 Effect of a Nurse-Led Multidisciplinary Heart Failure Clinic on Patient's Adherence: A Randomized Trial

FMMP5 Effect of a Nurse-Led Multidisciplinary Heart Failure Clinic on Patient's Adherence: A Randomized Trial

Equality in the Care and Treatment of Immigrants and Native Swedes—A Comparative Study of Patients Hospitalised for Heart Failure

The aim of this study was to compare immigrant and Swedish patients with heart failure (HF) regarding symptoms, diagnosis, medical treatment, discharge planning, readmission and mortality. The method was descriptive and retrospective using an audit protocol to review data from 214 medical records of 107 immigrants and 107 Swedish patients hospitalised for HF or chronic heart failure during 1994-2003. Descriptive statistics and significance testing were performed. Few differences between the patient groups were observed. Significantly larger number of immigrants were referred to the nurse-led HF clinic follow-up visits (P=0.026). Significantly more immigrants had ischemic heart disease on admission (P=0.025) and were prescribed short-acting nitrates at discharge (P=0.026). More Swedes were prescribed medications for insomnia (P=0.029). More immigrants than Swedes are referred to HF clinic after discharge, suggesting that physicians rely on specialised nurses to provide follow-ups, tailored to the needs of immigrant patients. The study indicates that the Swedish health care system has achieved its aim of equality in the care and treatment of this patient group. Further studies are needed to determine if this also applies to the quality of the provided care and treatment.

Nurse-led heart failure clinic in a rural setting a success

Nurse-led heart failure clinic in a rural setting a success

Treatment with beta‐blockers in nurse‐led heart failure clinics: Titration efficacy and predictors of failure

Beta-blockers (BBs) are a cornerstone in the treatment of chronic heart failure (HF), but several surveys have documented that many patients are not offered treatment or are not titrated to target doses. In part to address this problem, specialized, nurse-led HF clinics have been initiated in many countries. However, little information is available to describe if such programs are successful in initiating and up-titrating BBs in daily clinical practice. To assess the proportion of patients with HF due to left ventricular systolic dysfunction on BB treatment three months after referral to a nurse-led HF clinic, and to identify baseline predictors of treatment failure. Consecutive records from 14 Danish nurse-led HF clinics were used. 1533 patients met inclusion criteria. Mean age was 68.7 years and 72% were men. Three months after the initial HF clinic visit 63% of the patients were being treated with a BB. Mean dose (relative to target dose) was 63 (+/-35)% in patients receiving a BB and target dose was reached by 21%. Patients who were not on BBs were more often female, elderly and in NYHA class III-IV. In a multivariable model only lower age predicted BB use at three months (P<0.05). Younger age (P<0.001) and higher systolic blood pressure (P<0.001) were associated with higher doses of BB. BB up-titration continues to be a challenge even in specialized clinics dedicated to this task. Elderly patients appear to be less likely to receive treatment.

The Value of an Advanced Practice Nurse-Led Heart Failure Clinic as Demonstrated by Improvements in Kansas City Cardiomyopathy Questionnaire Scores

Background: It is often difficult to measure the benefits of innovative changes in healthcare delivery. Beyond merely quantifying improved adherence to heart failure (HF) guidelines, we sought to define the merits of an advanced practice nurse (APN)-led HF clinic from the perspective of patient (pt)-centered outcomes. Methods: NYHA class 2-4 HF pts referred to an APN-led HF clinic completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) at the time of enrollment and 3 months later. Results: 124 pts (64% Caucasians; 35% African Americans; 39% women; mean age 65.1 ± 15.1 yrs; mean LVEF 29.9 ± 10.4%) completed 2 KCCQs.

312 5 years on - nurse-led heart failure clinics: hospitalisation and survival

312 5 years on - nurse-led heart failure clinics: hospitalisation and survival

269 From nurse-led heart failure clinic to device therapy - an important step for patients in the management of their heart failure

269 From nurse-led heart failure clinic to device therapy - an important step for patients in the management of their heart failure

Cardiac rehabilitation for patients with heart failure: A service development audit

Background: Chronic heart failure (CHF) is a growing public health problem. Interventions such as drug treatments education and specialist nurse involvement have all improved outcomes. Evidence suggests tailored exercise programmes reduce hospitalization levels and improve mortality. National and international guidelines recommend that exercise programmes form part of an overall care package for patients with CHF. However, conventional cardiac rehabilitation services have been reluctant to prescribe exercise for this group of patients. Objectives: The aims were to investigate whether tailored classes for patients with CHF can be provided safely and without excessive costs and whether they can improve quality of life. Methods: Patients attending the nurse-led heart failure clinic were assessed for their suitability for cardiac rehabilitation. Those considered suitable were invited to attend an exercise-based cardiac rehabilitation programme lasting between 14 and 16 weeks. Twelve patients took part and they were divided into two groups. Baseline physiological and psychological assessments were undertaken at the beginning of the programme and these were reasessed at the end using the Borg and the Hospital Anxiety and Depression Scales. Results: Both groups showed improvements in exercise performance. As a result their ability to perform routine daily tasks was improved. In addition, some of the patients showed reduced levels of anxiety, 82% of patients felt that the programme helped them deal with their problems and some patients reported increased confidence levels. Conclusions: Cardiac rehabilitation can be provided safely for patients with CHF. The classes produced improved physical and psychological wellbeing for the patients. More research is needed into the benefits of cardiac rehabilitation for patients with heart failure.

700 Influence of perceived psychosocial support on self care behaviour of patients with chronic heart failure managed in nurse-led heart failure clinics

700 Influence of perceived psychosocial support on self care behaviour of patients with chronic heart failure managed in nurse-led heart failure clinics

Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study

To ascertain nurses' and patients' views and experiences of a nurse-led heart failure clinic provided in general practice. The study was set in eight general practices in the North-West of England. Semi-structured interviews were devised and administered, with all the nurses providing the clinics and a purposive sample of patients attending the clinics. The interviews were tape-recorded and transcribed. Constant comparative analysis was used to identify key issues and themes. Nurses felt that the self-care advice provided had empowered patients to manage their condition. Explaining why a medication had been prescribed, and how it controlled heart failure, was felt to increase compliance. Although communication was deemed good, some patients were reticent about asking questions. Patients were knowledgeable about their prescribed heart failure medications, but some did not recall having discussed their medications. Also, medication inserts led some patients to question their prescription. Patients remained confused about the purpose and outcome of investigations. Furthermore, many patients suggested that they had problems adhering to or remembering the advice given. There are practical benefits to be obtained from attending a nurse-led heart failure clinic in primary care. However, patients and healthcare providers may have quite divergent views about such a service and its benefits, emphasizing the potential value of consumer involvement and feedback when developing and delivering such services.

Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse-led heart failure clinics. A meta-regression analysis

To determine whether a hierarchy of effectiveness exists with respect to complexity of published protocols of heart failure (HF) disease management (DM) incorporating specialist nurse-led HF clinics. We searched MEDLINE (1966-November 2004), the Cochrane Library, article bibliographies, and contacted experts. Inclusion criteria were random allocation of at least 100 patients, specialist HF nurses, HF clinics, and readmission as an outcome measure. Paired reviewers conducted quality assessment, deconstructed and categorized protocols by complexity, and extracted results for readmission, mortality, the combined endpoint of mortality and hospitalization, HF readmission, and hospital days utilized. Six trials were selected (N=949, mean age 73 years [range 62-79], men 58%, LVEF 34% [27-41], and average follow-up of 8.5 months [3-12]). Compared with usual care, the overall relative risk [95% confidence interval] for readmission with this strategy was 0.91 [0.72, 1.16], mortality was 0.80 [0.57, 1.06], and the combined endpoint of mortality and hospitalization was 0.88 [0.74, 1.04]. We observed better outcomes for programs with versus programs without hospital discharge planning and immediate post-discharge follow-up; readmission 0.30 [0.04, 2.60] vs. 1.00 [0.86, 1.17], mortality 0.96 [0.63, 1.47] vs. 0.75 [0.55, 1.03], the combined endpoint of mortality and hospitalization 0.61 [0.18, 2.02] vs. 0.91 [0.80, 1.03], HF readmission 0.09 [0.10, 0.65] vs. 0.65 [0.43, 1.00], and hospitalized days utilized per patient -0.26 [-0.49,-0.02] vs. 0.09 [-1.17, 1.34]. HF DM with specialist nurse-led HF clinics is a promising strategy or effective alternative whose benefit may be optimized by programs with a homogeneous structure and components that are delivered with consistency.

Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study

Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study

Effects of a nurse-based heart failure clinic on drug utilization and admissions in a community hospital setting

Objective. To evaluate the effect of a nurse-led heart failure clinic on drug therapy and hospitalization in a community hospital setting. Design. Prospective, observational study of outpatients referred to a heart failure clinic. Nurses directed drug uptitration and delivered patient education. Utilization and doses of ACE inhibitors and beta-blockers were analyzed as were heart failure related admissions in the years before and after establishing the clinic. Results. 138 patients (median age 68.5 years) were enrolled. After three months 94% of patients were taking an ACE inhibitor and beta-blockade was prescribed for 91%. Mean ACE inhibitor dose relative to target dose after three months was 77±30% and mean beta-blocker dose was 53±31% of the target dose. Heart failure admissions decreased by 45% after the clinic was established. Conclusions. Community hospital based heart failure clinics may promote utilization of evidence based drug therapy and cause a substantial decrease in heart failure admissions, producing results comparable to those obtained in studies of university hospital based heart failure management programs.

Nurse-led heart failure clinics: Swedish experiences of Advanced Nursing Practice during 10 years

This paper aims at describing the development of nurse-led heart failure clinics in Sweden and discusses what effects and possibilities this type of advanced nursing practice gives the patients, the health care system and the nurses. Follow-up at nurse-led heart failure clinics involve patient education, optimised treatment and social support and has been shown to improve survival and self-care behaviour in patients with heart failure and reduce the need for hospital care. This model of care has spread from Sweden to many European countries, but still only a minority of the patients hospitalised due to heart failure receive this type of follow-up. It should be considered for several more patients in Europe. The organisation of the nurse-led follow-up needs to be adapted to the different needs of patients within the heart failure population and to the health care system of each country. Formal competence among heart failure nurses needs to be continuously improved in order to provide high-quality care to heart failure patients. This can be achieved through improved education and increased national and international collaboration among heart failure nurses. Networking among heart failure nurses on a regional, national and international level is crucial. Joint activities such as study visits, national and international working groups, conferences, workshops and research collaboration can be important tools in this development.

194 Prevalence and characteristics of nurse-led heart failure clinics in Denmark

194 Prevalence and characteristics of nurse-led heart failure clinics in Denmark