A nurse‐based strategy reduces heart failure morbidity in patients admitted for acute decompensated heart failure in Brazil: the HELEN‐II clinical trial

Abstract

Aims Home‐based interventions for heart failure (HF) patients might be particularly effective in middle‐income countries, where social, cultural, and economic constraints limit the effectiveness of HF treatment outside the hospital environment. Methods and results HELEN‐II was a randomized clinical trial conducted in Brazil designed to evaluate the clinical efficacy of a nurse‐based strategy, started after discharge following an acute decompensated HF (ADHF) admission. HELEN‐II compares the efficacy of home visits and telephone reinforcement (n = 123) with that of the conventional strategy, which is based on medical follow‐up (n = 129). The primary outcome was a composite endpoint of a first visit to the emergency department (≤24 h), a hospital readmission (>24 h), or all‐cause death, assessed during the first 6 months of follow‐up. Most enrolled subjects were middle‐aged (62 ± 13 years) males (63%) in NYHA functional class II–III (84%) with severe LV dysfunction (mean LVEF 29.6 ± 9%). The primary composite endpoint was decreased by 27% in the interventional group (relative risk 0.73; 95% confidence interval 0.54–0.99; P = 0.049). At the end of follow‐up, the rate of use of the standard‐of‐care HF medications was similar in both groups, except for the higher use of furosemide in the interventional group. Also, HF knowledge and self‐care were significantly increased in the interventional group. Conclusions A post‐discharge, nurse‐led management strategy significantly decreases the morbidity of ADHF patients in the public health system of a developing middle‐income country. Trial registration NCT01213875

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