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Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: does more equal less?
Author(s) -
Driscoll Andrea,
Tonkin Andrew,
Stewart Andrew,
WorrallCarter Linda,
Thompson David R,
Riegel Barbara,
Hare David L,
Davidson Patricia M,
Mulvany Christine,
Stewart Simon
Publication year - 2013
Publication title -
journal of clinical nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.94
H-Index - 102
eISSN - 1365-2702
pISSN - 0962-1067
DOI - 10.1111/jocn.12073
Subject(s) - heart failure , medicine , prospective cohort study , psychological intervention , cohort , cohort study , physical therapy , emergency medicine , cardiology , nursing
Aims and objectives To compare the efficacy of chronic heart failure management programmes ( CHF ‐ MP s) according to a scoring algorithm used to quantify the level of applied interventions–the Heart Failure Intervention Score ( HF ‐ IS ). Background The overall efficacy of heart failure programmes has been proven in several meta‐analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes. Design Prospective cohort study of patients participating in heart failure programmes. Method Forty‐eight of 62 (77%) programmes in Australia participating in a national register of CHF ‐ MP s were evaluated using the HF ‐ IS : derived from a summed and weighted score of each intervention applied by the CHF ‐ MP (27 interventions overall). The CHF ‐ MP s were prospectively categorised as relatively low ( HF ‐ IS < 190 – n = 39 programmes & 407 patients) or high ( HF ‐ IS ≥ 190 – n = 9 programmes & 166 patients) in complexity. Six‐month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II – IV were prospectively examined. Results Patients exposed to CHF ‐ MP s with a high HF ‐ IS had a lower rate of unplanned, all‐cause hospitalisation ( n = 24, 14% vs. n = 102, 25%) compared with CHF ‐ MP s with a low HF ‐ IS within six months. On an adjusted basis, CHF ‐ MP s with a high HF ‐ IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event‐free longer. Conclusion High complexity CHF ‐ MP s applying more evidence‐based interventions are associated with a higher event‐free survival over six months. Relevance to clinical practice The HF ‐ IS is an easy‐to‐use evidence‐based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.