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A specialist-nurse intervention reduced readmissions in patients hospitalized with chronic heart failure

Mandeep R. Mehra, MD
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*See Glossary.

†Information provided by author.

Source of funding: Scottish Office, Department of Health.

For correspondence: Dr. J.J. McMurray, Western Infirmary, Glasgow, Scotland, UK. E-mail j.mcmurray@bio.gla.ac.uk.

Ann Intern Med. 2002;136(3):87. doi:10.7326/ACPJC-2002-136-3-087
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Question: Can a specialist-nurse intervention reduce mortality and morbidity in patients hospitalized with chronic heart failure?

Design: Randomized (allocation concealed*), blinded {outcome assessors}†,* controlled trial with follow-up at 1 year.

Setting: An acute medical admissions unit at a teaching hospital in Glasgow, Scotland, United Kingdom.

Patients: 165 patients (mean age 75 y, 58% men) who were admitted on an emergency basis with heart failure caused by left ventricular systolic dysfunction. Exclusion criteria were inability to comply with the intervention, acute myocardial infarction, comorbidity likely to lead to death or readmission in the near future, planned discharge to long-term residential care, or residence outside of the hospital catchment area. Follow-up at 1 year was 95%.

Intervention: 84 patients were allocated to usual care plus a specialist-nurse intervention, which consisted of planned home visits of decreasing frequency supplemented by telephone contact as needed. The aim was to educate patients about heart failure and its treatment, optimize treatment, monitor electrolyte levels, teach self-monitoring and management, encourage treatment adherence, liaise with other health care providers, and provide psychological support. Nurses were given training and followed written protocols on the use of specific drugs. Patients were given a pocket-sized booklet that included information about heart failure and its treatment; contact information for nurses; a list of their drugs, weight, and blood test results; and details of planned visits. 81 patients were allocated to usual care and managed by the admitting physician and subsequently the general practitioner. They did not see the specialist nurses after discharge.

Main outcome measures: Combined outcome of death or readmission for heart failure (emergency or elective). Secondary outcomes included combined death or readmission for any reason, death, readmission for worsening chronic heart failure, and readmission for any reason.

Main results: At 1 year, fewer patients in the specialist-nurse group than in the usual-care group had the combined outcome of death or readmission for heart failure, and fewer were readmitted for heart failure (Table). The groups did not differ for combined death or readmission for any reason (62% vs 75%, P = 0.075), death (30% vs 31%, P = 0.81), or for readmission for any reason (56% vs 60%, P = 0.27).

Conclusion: A specialist-nurse intervention reduced readmissions for heart failure in patients admitted to the hospital with chronic heart failure.

A specialist-nurse intervention vs usual care for chronic heart failure (HF)‡

Outcomes at 1 yInterventionUsual careRRR (95% CI)NNT (CI)
Death or readmission for HF37%53%30% (3 to 53)7 (4 to 70)
Readmission for HF14%32%57% (21 to 78)6 (5 to 16)

‡Abbreviations defined in Glossary; RRR, NNT, and CI calculated from data in article.





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