Nurse-led follow-ups in chronic heart failure patients

Abstract

Background Heart failure (HF) has developed into a major burden and a world-wide epidemic. Many patients experience frequent exacerbations and recurrent hospital readmissions and ultimately death. The reason for this may be inadequate HF follow-up care, which is an important aspect of disease management. The research question The PICO framework was used to formulate the research question that is: Are nurse-led follow-ups for Chronic HF patients effective in reducing mortality and re-admission to hospital? Population: Adults over 18 years of age with chronic HF who were previously hospitalised. Time for admission was limited to the previous 6 months. Interventions: attendance to clinics, home-visits, telephone checks, telemonitoring or a combination of these methods; nurse-led follow-up with or without the support of a multidisciplinary team. Comparison intervention: patients receiving standard post-discharge care. Outcomes: the frequency of re-admission to hospital, and death rate. Secondary outcomes included patient satisfaction and compliance, quality of life and cost. Selection criteria Inclusion criteria: Systematic reviews and RCTs (published after 2006) that recruited participants over 18 years of age previously hospitalised over less than 6 months ago due to their illness; studies that consisted of interventions provided by a multidisciplinary team but were nurse-led or by the nurse without any support. Interventions consisted of telephone calls, home visits, telemonitoring (including structured telephone support) and/or attendance to clinics. Exclusion criteria: RCTs published before the year 2006; participants aged below 18 years of age; interventions that commenced during the patient's stay in hospital; studies that did not include a comparison group receiving usual care.

Search strategy and Data collection CinaHL, Medline, Psyclnfo and Cochrane Central of Register of Controlled Trials were searched during the months of October 2011 and November 2011. The PRISM A guidelines were used to guide the retention of relevant papers. Methods of appraisal The AMSTAR and PEDro tools were used to appraise the systematic reviews and RCTs, respectively, and put into a hierarchy of evidence according to their appropriate ranking scores. Main results The initial search results in the identification of 1, 791 papers of which 10 systematic reviews and 9 RCTs were retained. In the strongest reviews, telemonitoring and structured telephone support resulted in statistically significant improvements in all cause mortality and all-cause/HF-related re-admission rates. Results showed that home based interventions and attendance to clinics were not significantly effective. Main conclusions Structured telephone support and telemonitoring are effective in reducing mortality and readmission rates in patients with chronic HF. Evidence from this review shows that nurse-led home visits and nurse-led HF clinics did not result in significantly better outcomes when compared to standard care. Implications and recommendations Further research is needed to identify whether structured telephone support is truly as effective as telemonitoring. An important practical implementation is the introduction of nurse-led structured telephone support locally. It is recommended that specialized training is delivered to Maltese nurses to advance their knowledge and change their current practice