Impact of patient education on chronic heart failure in primary care (ETIC): a cluster randomised trial

Vaillant-Roussel, Hélène; Laporte, Catherine; Pereira, Bruno; Rosa, Marion De; Eschalier, Bénédicte; Vorilhon, Charles; Eschalier, Romain; Clément, Gilles; Pouchain, Denis; Chenot, Jean‐François; Dubray, Claude; Vorilhon, Philippe

doi:10.1186/s12875-016-0473-4

Cited by 24 publications

(45 citation statements)

References 35 publications

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“…In the OSCAR-HF population, the typical HF phenotype of general practice patients (older, high proportion of women, and high prevalence of hypertension) was confirmed and was even more pronounced than in other primary care cohorts. 1,3,8,29,31 The latter can be explained by our non-selective identification method and reporting; for example, the exclusion of the non-classifiable patients would have led to a lower mean age. A low percentage of HFrEF patients was reported, as in most recent primary care studies; however, this percentage is strongly dependent of the total number of HF patients in the cohort (total vs. objectified diagnoses alone-20% vs. 31%).…”

Section: Characteristics Of Heart Failure Patients In General Practicementioning

confidence: 99%

Impact of an extended audit on identifying heart failure patients in general practice: baseline results of the OSCAR‐HF pilot study

et al. 2020

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Aims Identifying heart failure (HF) patients in general practice is challenging, and little is known about the current quality of care. We implemented an extended audit from the electronic health records (EHRs) of general practitioners (GPs) to identify HF patients and investigate patient characteristics and quality of care. Methods and results This study describes the baseline results of the OSCAR-HF pilot study in eight general practices (51 GPs) in Flanders, Belgium. This prospective trial ran for 6 months. Interventions included an extended audit, an N-terminal pro-Btype natriuretic peptide point-of-care test, and assistance of a specialist HF nurse. The extended audit searched on risk factors for HF, HF symptoms, signs, and medication in the GPs' EHR to generate a list of possible HF patients. GPs determined which patients had HF. Those HF patients constituted the OSCAR-HF study population. Each patient file was manually revised to extract biomarker measurements, echocardiography data, and quality indicators. An independent panel of experts assessed the validity of GPs' HF diagnoses. Feedback about the validity of the HF diagnosis was given to the GP. Out of 18 011 patients ≥ 40 years, we identified 310 patients with a registered HF diagnosis before the study start (HF prevalence: 1.7%). The extended audit led to a 74% increase in identified HF patients (n = 538, HF prevalence: 3.0%) with a mean age of 79 ± 11 years. The prevalence of HF with reduced ejection fraction (HFrEF) was 20% (n = 110). A high proportion of patients underwent echocardiography in the past 5 years (86%, n = 462). Natriuretic peptides were rarely available in patients' files (19%, n = 100). Medical specialists should improve communication about the HF diagnosis because a specialist diagnosis was present in only 225 patients (42%) while 67% (n = 359) of the HF diagnoses were judged objectified by a panel of experts. Assigning a diagnosis of HF was particularly difficult in HF patients with preserved EF (HFpEF). HFrEF treatment rates with renin-angiotensin-aldosterone system blockers (84%, n = 92) and beta-blockers (86%, n = 94) were very good; however, target doses were hardly reached (34% and 14%, respectively). Conclusions This study highlighted the need to improve case finding for HF in general practice and showed that an extended audit in the GPs' EHR was a successful strategy to do so. To improve the quality of HF care in general practice, specific strategies are needed to diagnose HFpEF and to reach target doses of disease-modifying drugs in HFrEF patients.

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Section: Characteristics Of Heart Failure Patients In General Practicementioning

confidence: 99%

Impact of an extended audit on identifying heart failure patients in general practice: baseline results of the OSCAR‐HF pilot study

et al. 2020

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“…Pocket cards with HF evidence-based interventions and structured educational programmes22 have been shown to be useful. Other studies have shown that educational programmes directed to family medicine and internal medicine physicians show no differences in prescribing patterns for HF management or improvement of patients’ quality of life 20 25. Physician education was one of the major interventions in this QI.…”

Section: Discussionmentioning

confidence: 91%

Optimisation of diagnosis and treatment of heart failure in a primary care setting

et al. 2019

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BackgroundHeart failure (HF) is one of the leading causes of emergency department visits and hospital admissions in the USA. We identified a gap in the diagnosis and the use of guideline-directed medical therapy in patients with HF at the internal medicine clinic.AimTo improve the diagnosis and treatment of HF, as well as to reduce emergency department visits and hospitalisation over 12 months in patients aged 40–75 years.MethodsThe multidisciplinary quality improvement (QI) team performed a root cause analysis and identified barriers to optimal guideline-directed medical therapy. Rates of patients on guideline-directed medical therapy with systolic HF diagnosis, emergency department visits and hospital admissions were the outcome measures. The process measures included echocardiogram order and completion rates, and rates of accurate classification of HF from the baseline rate of less than 10%. We used the focus, analyse, develop, execute and evaluate (FADE) model with five improvement cycles. The major components of interventions included (1) leveraging health information technology; (2) optimising teamwork; and (3) providing education to patients, physicians and internal medicine clinic staff. Data were analysed using statistical process control and run charts.ResultsWe observed a reduction in the total number of emergency department visits (160 vs 108), hospital admissions (117 vs 114) and observation visits (22 vs 16) comparing the 1-year preproject and 1-year postproject periods. An increase in the use of ACE inhibitors or angiotensin receptor blockers occurred from the baseline rate of 20%–37% during the second half of the project and was sustained at 71.4% (median) during 6 months of the postproject period.ConclusionsWe achieved a sustainable increase in the accurate diagnosis of HF and achieved 80% diagnosis during the 6-month poststudy period.

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“…6 However, compliance to treatment regimens and patient understanding and ability to manage their condition, especially before decompensation events, is suboptimal. 30 For many patients with heart failure, drug regimens can include up to six medications, some scheduled up to three-times per day. Patients must also adhere to salt-restricted diets and observe fluid restrictions.…”

Section: Patient-facing Data and Tools For All Heart Failurementioning

confidence: 99%

“…While several studies have attempted to provide patients with a continuing model of disease management support outside hospital, little improvement has been made in reducing event rates with nurse phone calls or intermittent home visits. 30,31 Cardiac rhythm devices and haemodynamic monitoring data provide crucial information to the treating physician. This continuous ambulatory data guides dynamic changes to medical therapy and improves all-cause outcomes.…”

Section: Patient-facing Data and Tools For All Heart Failurementioning

confidence: 99%

Haemodynamic Monitoring Devices in Heart Failure: Maximising Benefit with Digitally Enabled Patient Centric Care

Raj

Saxon

2018

Arrhythmia &Amp; Electrophysiology Review

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ICDs and resynchronisation devices are routinely implanted in patients with heart failure for primary prevention of sudden cardiac death or to treat the condition. The addition of device features and algorithms that directly or indirectly monitor cardiac haemodynamics to assess heart failure status can provide additional benefit by treating heart failure more continuously. Established and emerging devices and sensors aimed at treating or measuring cardiac haemodynamics represent the next era of heart failure disease management. Digitally enabled models of heart failure care, based on frequent haemodynamic measurements, will increasingly involve patients in their own disease management. Software tools and services tailored to provide patients with personalised information to guide diet, activity, medications and haemodynamic management offer an unprecedented opportunity to improve patient outcomes. This will enable physicians to care for larger populations because management will be exception based, automated and no longer depend on one-to-one patient and physician interactions.

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Impact of patient education on chronic heart failure in primary care (ETIC): a cluster randomised trial

Cited by 24 publications

References 35 publications

Impact of an extended audit on identifying heart failure patients in general practice: baseline results of the OSCAR‐HF pilot study

Impact of an extended audit on identifying heart failure patients in general practice: baseline results of the OSCAR‐HF pilot study

Optimisation of diagnosis and treatment of heart failure in a primary care setting

Haemodynamic Monitoring Devices in Heart Failure: Maximising Benefit with Digitally Enabled Patient Centric Care

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