Multidisciplinary strategies for the management of heart failure patients at high risk for admission

Abstract

Multidisciplinary strategies for the management of patients with HF reduce HF hospitalizations. Those programs that involve specialized follow-up by a multidisciplinary team also reduce mortality and all-cause hospitalizations.

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…During the past few years, a number of systematic reviews and larger randomized controlled trials (122)(123)(124)(125)(126)(127) have been performed to better estimate the effects of DMPs for HF patients on mortality and morbidity. These reviews generally found that DMPs reduce both all-cause and HF hospitalizations (122,123,(125)(126)(127). One review (124) reported a trend to reduce hospitalization rather than a significant reduction.…”

“…Pooled data from several meta-analyses (122,123,127) have demonstrated a significant reduction in mortality of 25%. Other studies have either not examined mortality (126) or examined it in a combined outcome of hospital readmission or death, showing an 18% decrease (125).…”

“…However, the published overview analyses have been able to provide some direction with regard to the most effective type of DMP. Multidisciplinary programs involving both a doctor and a nurse specializing in HF management appear to be a consistent requirement for these programs, with the potential for further benefit from the addition of other allied health professionals such as a pharmacist (122,123,126,127,138). Combinations of in-clinic and telephone follow-ups would appear to be important with entry into the DMP as soon as possible after discharge (122,124,125).…”

“…Combinations of in-clinic and telephone follow-ups would appear to be important with entry into the DMP as soon as possible after discharge (122,124,125). The DMP should involve education, exercise and psychosocial counselling, selfcare supportive strategy, optimization of the medication regimen and medical referrals for deterioration (122,124,125,127).…”

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

“…2 Heart failure disease management programmes can reduce readmission rates and mortality. 3,4 Although the interventions vary, a multi-disciplinary team approach with specialist heart failure nurses playing a pivotal role in monitoring signs and symptoms, optimizing medication, providing education, co-ordinating care, and facilitating self-care is now recommended in international guidelines. 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.…”