Copyright © 2003 by the European Society of Cardiology.
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Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure
Results from a prospective, randomised trial
a Department of Cardiology, Heart Centre, Linköping University Hospital, Linköping, Sweden
b Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
c School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
d Department of Medicine, County Hospital Ryhov, Jönköping, Sweden
e Unit of Research and Development in Primary Health Care, Jönköping, Sweden
f Department of Nursing, Lund University, Lund, Sweden
g Center for Medical Technology Assessment, Department of Health and Society, Linköping University, Linköping, Sweden
* Corresponding author: Anna Strömberg, Department of Cardiology, University Hospital, S-581 85 Linköping, Sweden. Tel.: +46-13-227762, fax: +46-13-222224
E-mail address: annst{at}imv.liu.se
Received 3 December 2002; revised 7 February 2003; accepted 10 February 2003
Aim The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge.
Methods A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2–3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family.
Results There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01).
Conclusions Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.
Key Words: Heart failure • Heart failure clinics • Mortality • Nursing • Patient education • Self-care
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