Cochrane review says telephone follow-up of heart failure patients is effectiveBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6187 (Published 14 September 2012) Cite this as: BMJ 2012;345:e6187
A Cochrane systematic review has concluded that patients with chronic heart failure are less likely to die a year after discharge if they are offered case management—intense monitoring usually involving telephone follow-up by a specialist nurse and home visits. Such patients are also less likely to be readmitted to hospital in the six months after discharge.1
Chronic heart failure is becoming increasingly common as the population ages and carries high risks of emergency hospitalisation and death. In 2000 around 1.9% of the total budget of the NHS was spent on patients with heart failure and most of this cost was incurred by hospital admissions.
Researchers from the UK and Australia examined 25 randomised controlled trials involving 5942 people. All the patients had been previously admitted to hospital with chronic heart failure and were at high risk of readmission. The researchers classified the trials into three models: case management interventions where patients were intensively monitored by telephone calls and home visits, usually by a specialist nurse; clinic interventions involving follow-up in a specialist clinic; and multidisciplinary interventions.
The study found that case management interventions are associated with a significant reduction in all cause mortality at 12 months (odds ratio 0.66; 95% confidence interval 0.47 to 0.91). No reductions were seen for deaths from chronic heart failure or cardiovascular causes. However, case management interventions reduced readmissions related to chronic heart failure at six month (OR 0.64, 95%; 95% CI 0.46 to 0.88) and 12 months (OR 0.47; 95% CI 0.30 to 0.76) follow-up.
Stephanie Taylor, professor in public health and primary care at Barts and the London School of Medicine and one of the study authors told the BMJ: “I think there is now enough evidence to say that case management is effective. We now need more research on implementation and cost effectiveness. It may be that less intensive versions of case management can work well so we need to carefully examine the different components.”
The study authors say it is not possible to say what the optimal components of case management type interventions are but telephone follow-up by a nurse specialist was a common component. Taylor said: “Telephone calls may have reinforced self management and monitoring. In some cases patients were given algorithms on self management. Some patients were encouraged to weigh themselves daily or to look for warning signs such as swollen feet.”
Taylor said: “I think maybe in some parts of the country this sort of care may be happening but it is certainly not universal. The current NICE [National Institute for Health and Clinical Excellence] guidelines for heart failure don’t really talk in detail about models of follow-up.”
The British Heart Foundation supports 300 specialist heart failure nurses. Peter Weissberg, medical director at the charity, said: “It’s been shown time and again that admissions, and therefore costs, are reduced as a result of the work of specialist heart failure nurses. They can make an immeasurable difference to someone’s quality of life and many more people across the UK should have access to the follow up care they provide.”
Cite this as: BMJ 2012;345:e6187