Nurse‐coordinated collaborative disease management improves the quality of guideline‐recommended heart failure therapy, patient‐reported outcomes, and left ventricular remodelling

Abstract

BackgroundHeart failure (HF) pharmacotherapy is often not prescribed according to guidelines. This longitudinal study investigated prescription rates and dosages of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers, and mineralocorticoid receptor antagonists (MRA), and concomitant changes of symptoms, echocardiographic parameters of left ventricular (LV) Methods and resultsThe INH study evaluated a nurse-coordinated management, HeartNetCare-HF TM (HNC), against Usual Care (UC) in patients hospitalized for decompensated HF [LV ejection fraction (LVEF) ≤40% before discharge). A total of 706 subjects surviving >18 months (363 UC, 343 HNC) were examined 6-monthly. At baseline, 92% received ACEi/ARB, (HNC/UC 91/93%, P = 0.28), 86% received beta-blockers (86/86%, P = 0.83), and 44% received MRA (42/47%, P = 0.07). After 18 months, beta-blocker use had increased only in HNC (+7.6%, P < 0.001). Guideline-recommended target doses were achieved more frequently in HNC for ACEi/ARB (HNC/UC: 50/25%, P < 0.001) and beta-blockers (39/15%, P < 0.001). The following variables were more improved and/or better in subjects undergoing HNC compared with UC: LVEF (47 ± 12 vs. 44 ± 12%, P = 0.004, change +17/+14%, P = 0.010), LV end-diastolic diameter (59 ± 9 vs. 61 ± 9.6 mm, P = 0.024, change −2.3/-1.4mm, P = 0.13), New York Heart Association class (1.9 ± 0.7 vs. 2.1 ± 0.7, P = 0.001, change −0.44/-0.25, P = 0.002) and SF-36 physical component summary score (41.6 ± 11.2 vs. 38.5 ± 11.8, P = 0.004, change +3.3 vs. +1

Avoiding Untimely Implantable Cardioverter/Defibrillator Implantation by Intensified Heart Failure Therapy Optimization Supported by the Wearable Cardioverter/Defibrillator—The PROLONG Study

“…Dosages of beta‐blockers, renin‐angiotensin system (RAS) antagonists and MRA were significantly higher at 3‐month follow‐up compared to hospital discharge and were comparable to a recent randomized study on optimization of heart failure medication management 22. We found that delayed improvers had significantly higher dosages of MRA than nonimprovers.…”

Prognostic potential of midregional pro‐adrenomedullin following decompensation for systolic heart failure: comparison with cardiac natriuretic peptides

“…While lower quality of HF treatment was associated with higher or increasing MR‐proADM, patients on higher ACEi/ARB and beta‐blocker doses at baseline and F6 had lower levels of this biomarker. This is consistent with findings that patients with a higher comorbidity burden tolerate up‐titration of guideline‐recommended cardiac drugs less well . Additionally, reverse LV remodelling was significantly more common in study participants with consistently low MR‐proADM levels.…”

Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…As key members of the multidisciplinary team, they are responsible for the 24 h monitoring of patients admitted with AHF ensuring effective communication among professionals as well as education and support to patients and caregivers. Over recent years, evidence has shown the value of nurse‐led interventions, in terms of improved survival and quality of life as well as reduced length of hospital stay and rates of readmission . Reviewing patients during the critical post‐discharge phase (7–14 days) enables evaluation of clinical status and patient's self‐management behaviours.…”