BMJ 2001;323:715-718 ( 29 September )

Papers

Randomised controlled trial of specialist nurse intervention in heart failure

Lynda Blue, specialist nurse, a Elanor Lang, specialist nurse, a John J V McMurray, professor of medical cardiology, a Andrew P Davie, specialist registrar in cardiology, a Theresa A McDonagh, senior lecturer in medical cardiology, a David R Murdoch, specialist registrar in cardiology, a Mark C Petrie, specialist registrar in cardiology, a Eugene Connolly, staff grade in cardiology, a John Norrie, statistician, b Caroline E Round, statistician, b Ian Ford, professor of statistics, b Caroline E Morrison, consultant in public health medicine. c

a Department of Cardiology, Western Infirmary, Dumbarton Road, Glasgow G12 6NT, b Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, c Greater Glasgow Health Board, Dalian House, Glasgow G3 8YT

Correspondence to: J J V McMurray j.mcmurray{at}bio.gla.ac.uk

Objectives: To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure.
Design: Randomised controlled trial.
Setting: Acute medical admissions unit in a teaching hospital.
Participants: 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year.
Main outcome measures: Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure.
Results: 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96).Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051).
Conclusions: Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.


What is already known on this topic
Studies have suggested that nurse intervention may reduce readmission in patients with heart failure

What this study adds
Home based intervention from nurses reduces readmissions for worsening heart failure

Regular contact to review treatment and patient education are likely to contribute to this effect



© BMJ 2001
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Relevant Articles

Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial
Richard Holland, Iain Brooksby, Elizabeth Lenaghan, Kate Ashton, Laura Hay, Richard Smith, Lee Shepstone, Alistair Lipp, Clare Daly, Amanda Howe, Roger Hall, and Ian Harvey
BMJ 2007 334: 1098. [Abstract] [Full Text] [PDF]

Telephone interventions for disease management in heart failure
Hugo O Grancelli and Daniel C Ferrante
BMJ 2007 334: 910-911. [Extract] [Full Text] [PDF]

Home intervention by nurses cuts readmission for heart failure
BMJ 2001 323: 0. [Full Text]

This article has been cited by other articles:

  • Paul, S. (2008). Hospital Discharge Education for Patients With Heart Failure: What Really Works and What Is the Evidence?. Crit Care Nurse 28: 66-82 [Full text]  
  • Khunti, K., Stone, M., Paul, S., Baines, J., Gisborne, L., Farooqi, A., Luan, X., Squire, I. (2007). Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial. Heart 93: 1398-1405 [Abstract] [Full text]  
  • Selman, L., Harding, R., Beynon, T., Hodson, F., Hazeldine, C., Coady, E., Gibbs, L., Higginson, I. J. (2007). Modelling services to meet the palliative care needs of chronic heart failure patients and their families: current practice in the UK. Palliat Med 21: 385-390 [Abstract]  
  • de la Porte, P. W F B.-A., Lok, D. J A, van Veldhuisen, D. J, van Wijngaarden, J., Cornel, J. H, Zuithoff, N. P A, Badings, E., Hoes, A. W (2007). Added value of a physician-and-nurse-directed heart failure clinic: results from the Deventer-Alkmaar heart failure study. Heart 93: 819-825 [Abstract] [Full text]  
  • Holland, R., Brooksby, I., Lenaghan, E., Ashton, K., Hay, L., Smith, R., Shepstone, L., Lipp, A., Daly, C., Howe, A., Hall, R., Harvey, I. (2007). Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial. BMJ 334: 1098-1098 [Abstract] [Full text]  
  • Grancelli, H. O, Ferrante, D. C (2007). Telephone interventions for disease management in heart failure. BMJ 334: 910-911 [Full text]  
  • Lyon, D., Lancaster, G. A, Taylor, S., Dowrick, C., Chellaswamy, H. (2007). Predicting the likelihood of emergency admission to hospital of older people: development and validation of the Emergency Admission Risk Likelihood Index (EARLI). Fam Pract 24: 158-167 [Abstract] [Full text]  
  • Krumholz, H. M., Currie, P. M., Riegel, B., Phillips, C. O., Peterson, E. D., Smith, R., Yancy, C. W., Faxon, D. P. (2006). A Taxonomy for Disease Management: A Scientific Statement From the American Heart Association Disease Management Taxonomy Writing Group. Circulation 114: 1432-1445 [Abstract] [Full text]  
  • Daley, A., Matthews, C., Williams, A. (2006). Heart failure and palliative care services working in partnership: report of a new model of care.. Palliat Med 20: 593-601 [Abstract]  
  • Yu, D. S.F., Thompson, D. R., Lee, D. T.F. (2006). Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes. Eur Heart J 27: 596-612 [Abstract] [Full text]  
  • Gillespie, N. D (2006). The diagnosis and management of chronic heart failure in the older patient. Br Med Bull 75-76: 49-62 [Abstract] [Full text]  
  • Holland, R, Battersby, J, Harvey, I, Lenaghan, E, Smith, J, Hay, L (2005). Systematic review of multidisciplinary interventions in heart failure. Heart 91: 899-906 [Abstract] [Full text]  
  • Smith, C. E., Koehler, J., Moore, J. M., Blanchard, E., Ellerbeck, E. (2005). Testing Videotape Education for Heart Failure. Clin Nurs Res 14: 191-205 [Abstract]  
  • Leslie, S J, McKee, S P, Imray, E A, Denvir, M A (2005). Management of chronic heart failure: perceived needs of general practitioners in light of the new general medical services contract. Postgrad. Med. J. 81: 321-326 [Abstract] [Full text]  
  • McDonagh, T A (2005). Lessons from the management of chronic heart failure. Heart 91: ii24-ii27 [Abstract] [Full text]  
  • Grange, J (2005). The role of nurses in the management of heart failure. Heart 91: ii39-ii42 [Abstract] [Full text]  
  • Lloyd-Williams, F., Beaton, S., Goldstein, P., Mair, F., May, C., Capewell, S. (2005). Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study. Chronic Illness 1: 39-47 [Abstract]  
  • Gonseth, J., Guallar-Castillon, P., Banegas, J. R., Rodriguez-Artalejo, F. (2004). The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J 25: 1570-1595 [Abstract] [Full text]  
  • Gustafsson, F., Arnold, J. M. O. (2004). Heart failure clinics and outpatient management: review of the evidence and call for quality assurance. Eur Heart J 25: 1596-1604 [Abstract] [Full text]  
  • George, J., Phun, Y.-T., Bailey, M. J, Kong, D. C., Stewart, K. (2004). Development and Validation of the Medication Regimen Complexity Index. The Annals of Pharmacotherapy 38: 1369-1376 [Abstract] [Full text]  
  • McAlister, F. A., Stewart, S., Ferrua, S., McMurray, J. J.J.V. (2004). Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials. J Am Coll Cardiol 44: 810-819 [Abstract] [Full text]  
  • Riegel, B., Naylor, M., Stewart, S., McMurray, J. J. V., Rich, M. W. (2004). Interventions to Prevent Readmission for Congestive Heart Failure. JAMA 291: 2816-2816 [Full text]  
  • Phillips, C. O., Wright, S. M., Kern, D. E., Rubin, H. R., Shepperd, S. (2004). Interventions to Prevent Readmission for Congestive Heart Failure--Reply. JAMA 291: 2816-2817 [Full text]  
  • Horne, G., Payne, S. (2004). Removing the boundaries: palliative care for patients with heart failure. Palliat Med 18: 291-296 [Abstract]  
  • Smales, C., Varia, H. (2004). Developing the role of the infectious diseases clinical nurse specialist. British Journal of Infection Control 5: 19-22 [Abstract]  
  • Phillips, C. O., Wright, S. M., Kern, D. E., Singa, R. M., Shepperd, S., Rubin, H. R. (2004). Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart Failure: A Meta-analysis. JAMA 291: 1358-1367 [Abstract] [Full text]  
  • Struthers, A. D. (2003). Should hospitals have a designated consultant with a specific interest in heart failure?. QJM 96: 877-879 [Full text]  
  • McKenzie, D B, Cowley, A J (2003). Drug therapy in chronic heart failure. Postgrad. Med. J. 79: 634-642 [Abstract] [Full text]  
  • New, J. P., Mason, J. M., Freemantle, N., Teasdale, S., Wong, L. M., Bruce, N. J., Burns, J. A., Gibson, J. M. (2003). Specialist Nurse-Led Intervention to Treat and Control Hypertension and Hyperlipidemia in Diabetes (SPLINT): A randomized controlled trial. Diabetes Care 26: 2250-2255 [Abstract] [Full text]  
  • Fisher, C, Berry, C, Blue, L, Morton, J J, McMurray, J (2003). N-terminal pro B type natriuretic peptide, but not the new putative cardiac hormone relaxin, predicts prognosis in patients with chronic heart failure. Heart 89: 879-881 [Abstract] [Full text]  
  • Kim, D. H., Hunt, S. A. (2003). Heart Failure Management: Caregiver Versus Care Plan. Circulation 108: 129-131 [Full text]  
  • Hughes, M. L, Leslie, S. J, McInnes, G. K, McCormac, K., Peden, N. R (2003). Can we see more outpatients without more doctors?. JRSM 96: 333-337 [Abstract] [Full text]  
  • Stromberg, A., Martensson, J., Fridlund, B., Levin, L-A, Karlsson, J.-E., Dahlstrom, U. (2003). Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: Results from a prospective, randomised trial. Eur Heart J 24: 1014-1023 [Abstract] [Full text]  
  • Davis, R. C, Bhatia, G., Sosin, M., Stubley, J., Lambert, M. F, Watt, I. S (2003). Barriers to managing heart failure in primary care. BMJ 326: 883-883 [Full text]  
  • Davis, R C, Hobbs, F D R, Kenkre, J E, Roalfe, A K, Hare, R, Lancashire, R J, Davies, M K (2002). Prevalence of left ventricular systolic dysfunction and heart failure in high risk patients: community based epidemiological study. BMJ 325: 1156-1156 [Abstract] [Full text]  
  • Stewart, S., McMurray, J. J V (2002). Palliative care for heart failure. BMJ 325: 915-916 [Full text]  
  • McIntyre, H F, Barrett, J, Murphy, S, Wray, R, Sutcliffe, S J, Walker, D M (2002). Across the interface: the Hastings Heart Function Clinic. Heart 88: ii23-27 [Full text]  
  • Hardman, S M C (2002). Heart failure: across the interface and beyond. Heart 88: ii28-32 [Full text]  
  • Jolly, L (2002). The role of the specialist nurse. Heart 88: ii33-35 [Full text]  
  • Hanratty, B., Hibbert, D., Mair, F., May, C., Ward, C., Capewell, S., Litva, A., Corcoran, G. (2002). Doctors' perceptions of palliative care for heart failure: focus group study. BMJ 325: 581-585 [Abstract] [Full text]  
  • Ekman, I., Swedberg, K. (2002). Home-based management of patients with chronic heart failure--focus on content not just form!. Eur Heart J 23: 1323-1325 [Full text]  
  • Stewart, S., Blue, L., Walker, A., Morrison, C., Mcmurray, J.J.V. (2002). An economic analysis of specialist heart failure nurse management in the U.K. Can we afford not to implement it?. Eur Heart J 23: 1369-1378 [Abstract] [Full text]  
  • Moser, D. K., Mann, D. L. (2002). Improving Outcomes in Heart Failure: It's Not Unusual Beyond Usual Care. Circulation 105: 2810-2812 [Full text]  
  • Stewart, S., Horowitz, J. D. (2002). Home-Based Intervention in Congestive Heart Failure: Long-Term Implications on Readmission and Survival. Circulation 105: 2861-2866 [Abstract] [Full text]  
  • Mosterd, A., Hoes, A.W. (2002). Reducing hospitalizations for heart failure. Eur Heart J 23: 842-845 [Full text]  
  • Mehra, M. R (2002). A specialist nurse intervention reduced readmissions in patients admitted to hospital with chronic heart failure. Evid. Based Med. 7: 83-83 [Full text]  
  • Newman, M. (2002). A specialist nurse intervention reduced hospital readmissions in patients with chronic heart failure. Evid. Based Nurs. 5: 55-55 [Full text]  
  • McMurray, J.J.V, Stewart, S (2002). The burden of heart failure. Eur Heart J Suppl 4: D50-D58 [Abstract]  
  • Zannad, F (2002). Evidence-based drug therapy for chronic heart failure. Eur Heart J Suppl 4: D66-D72 [Abstract]  
  • (2001). Specialist Nurses Improve Heart Failure Outcomes. JWatch General 2001: 8-8 [Full text]  

Rapid Responses:

Read all Rapid Responses

Specialtist nurse intervention in heart failure
E Hunter
bmj.com, 18 Oct 2001 [Full text]
Specialist nurse intervention in heart failure
Enda Ryan
bmj.com, 12 Nov 2001 [Full text]

Student BMJ

Asylum seekers' care

UK medical students have published unreleased government plans to restrict failed asylum seekers' access to medical care

www.student.bmj.com

Listen to the latest BMJ Interview