Heart failure programmes in countries with a primary care‐based health care system. Are additional trials necessary? Design of the DEAL‐HF study

Abstract

Background: Several randomised studies of heart failure (HF) management programmes in the United States, Australia and Europe have shown a considerable reduction in hospitalisation rates for HF. In this article, a comprehensive review of these studies will be provided and their applicability to countries, with a primary care-based healthcare system, will be discussed. In addition, the design of the DeventerAlkmaar HF Project (DEAL-HF), a randomised study of the effect of a nurse and physician-directed intervention over 1 year in The Netherlands, will also be presented. Aim: To discuss the applicability of the results of available studies on heart failure management programmes to countries with well-structured primary care facilities and to determine whether additional trials should be conducted in these countries. Methods: We performed a literature search in PubMed. In a review of the available studies, essential methodological aspects, in particular, the population involved, the sample size, follow-up period, setting, type of intervention, and the outcome parameters, are discussed critically. Also, the applicability of these studies to countries with a primary care-based healthcare system and easy access to medical care is evaluated. Conclusion: Applicability of the results of the available studies on the efficacy of heart failure management programmes to countries with a primary care-based health care system is doubtful. An efficacy trial in a country with a well-established primary care-based healthcare system, such as The Netherlands, is due to report soon (DEAL-HF).

Case management for patients with chronic systolic heart failure in primary care: The HICMan exploratory randomised controlled trial

“…While all programmes had a similar frequency of face-to-face contacts, the quality and the intensity of the medical care (e.g. investigations [12]) and educational content were higher in other studies [5,12,54]. Knowing these contextual differences with regard to training level and skills of staff, our intervention included a provider intervention (training of doctors' assistants and introduction for GPs) and used an elaborated standardised case management concept enabling doctors' assistants to deliver case management.…”

Plasma levels of alpha-1-antichymotrypsin are elevated in patients with chronic heart failure, but are of limited prognostic value

“…Patient material consisted of plasma and data obtained from the Deventer-Alkmaar Heart Failure study (DEAL-HF) [11, 12]. Briefly, 240 patients with typical signs and symptoms of HF were included, combined with echocardiographic or radionuclide ventriculographic findings of a reduced left ventricular systolic function (LVEF ≤ 45 %) or diastolic dysfunction.…”

Expert opinion of the Heart Failure Association of the Polish Society of Cardiology, the College of Family Physicians in Poland, and the Polish Society of Family Medicine on the peri discharge management of patients with heart failure

“…Many countries have programs in which HF nurses provide continuity of care, working closely with the family physician, cardiologist, patient, and his/her family/caregivers [113,114]. The role of the nurse focuses on: • educating the patient about his/her disease (definition, etiology, and risk factors of HF), symptoms that require a medical appointment, and factors that contribute to HF exacerbation; • taking part in monitoring patient adherence to therapeutic recommendations (drug dosage, options for flexible supply of diuretics); • providing advice and recommendations on diet, physical activity, fluid intake, recommended vaccinations, and more; • education on techniques for measuring heart rate, BP, saturation, respiratory rate, and body weight, assessing peripheral edema and feeling of dyspnea, as well as monitoring for any adverse effects of the treatment, pointing out the possibility of modifying doses of certain drugs (primarily diuretics and BP-lowering drugs).…”