Feasibility of a nurse-monitored, outpatient-care programme for elderly patients with moderate-to-severe, chronic heart failure

Abstract

Given the selection criteria and the outline of the interventions, the outpatient, nurse-monitored, symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe, chronic heart failure, mainly because of the small proportion of eligible patients and the high drop-out rate. Management of these patients would have to be more adjusted to their home situation.

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

“…Five studies reported that less than 50% of patients were at target doses [29,30,[33][34][35]. In the study by McDonald et al over 50% of enrollees received target doses of ACEIs [31,32]. This study also reported significant reductions in the primary outcomes we evaluated and the overall results favored intervention patients.…”

“…Cline et al [30] Ekman et al [31] McDonald et al [32]; Ledwidge et al [33] Doughty et al [34] Kasper et al [35] Stromberg et al [36] Discharge planning specifically or consistently defined. The median Jadad score was 3.5 (IQR 3-4).…”

“…Two programs were categorized as the most complex, containing an additional component for hospital discharge planning, immediate post-discharge follow-up, and no delay in continuity of the intervention after hospital discharge [30,32,33]. Programs without hospital discharge planning or with fewer components were categorized as less complex [31,[34][35][36]. variations in sample size between trials reporting this endpoint [30,32,33].…”

“…Although the pooled study population we reviewed was representative of most patients with chronic HF due to left ventricular systolic dysfunction, only a limited number of patients met eligibility criteria and were enrolled in the studies we reviewed (20.8% [range 5.4-45.8%]). In one study, 29% of patients randomized to the intervention did not attend the clinic because of fatigue [31]. Whereas this strategy did not reduce first readmission rate for very sick patients (NYHA III-IV, RR 0.99 [0.85, 1.17]), patients with better symptom control were more likely to derive benefit (NYHA II-III, RR 0.68 [0.32, 1.43]).…”

A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home‐HF study

“…5,6 Replicating these multi-disciplinary interventions in routine practice is challenging, as many elderly patients are not able to attend frequent clinic visits, there are a limited number of specialist nurses, and a limit on the number of patients with whom they can maintain frequent contact. 7 Importantly, in the UK only 20% of heart failure patients discharged from hospital have any form of specialist follow-up. 8 Telehealth has the potential to deliver specialist services closer to patients' homes.…”