Open AccessNurse‐led ambulatory care supported by non‐invasive haemodynamic assessment after acute heart failure decompensation
Author(s) -
Krzesiński Paweł,
Siebert Janusz,
Jankowska Ewa Anita,
Galas Agata,
Piotrowicz Katarzyna,
Stańczyk Adam,
Siwołowski Paweł,
Gutknecht Piotr,
Chrom Paweł,
Murawski Piotr,
Walczak Andrzej,
Szalewska Dominika,
Banasiak Waldemar,
Ponikowski Piotr,
Gielerak Grzegorz
Publication year - 2021
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13207
Subject(s) - decompensation , medicine , heart failure , hemodynamics , ambulatory , ejection fraction , cardiology , ambulatory care , impedance cardiography , intensive care medicine , emergency medicine , stroke volume , health care , economics , economic growth
Abstract Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended. Aims We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non‐invasive haemodynamic assessment, on the functional status, well‐being, and haemodynamic status of patients post‐acute HF decompensation. Methods and results This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non‐invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow‐up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class ( P = 0.013) and sense of well‐being as evaluated by a visual analogue score ( P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%). Conclusions The proposed model of nurse‐led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well‐being, and (iii) high rate of pharmacotherapy modifications.