Copyright © 2004 by the European Society of Cardiology.
Letter to the Editor
Heart failure clinics have decreased mortality and hospitalisation rates in Sweden
Department of Cardiology, Linköping University hospital, Department of Medicine and Care, Linköping University, S-581 85 Linköping, Sweden
* Tel.: +46-13-227762
E-mail address: annst{at}imv.liu.se
Schaufelberger et al.1 recently reported on how mortality and hospitalisation rates for heart failure have decreased during the last 20 years in Sweden. The authors concluded that improved drug treatment of both heart failure and the underlying disease together with the use of home-care programmes explained the decrease in incidence and the improved prognosis of heart failure in Sweden. However, there are some crucial aspects missing in the discussion on how structured follow-up may influence mortality and morbidity. Structured follow-up is very vaguely described as home-care with reference to an Australian setting, a model very rarely used in clinical practice and not tested in Sweden during the period of time reported in the study.
In Sweden, nurse-led heart failure clinics have been used for follow-up after hospitalisation since 1990 and between 1990 and 1998, heart failure clinics started in 2/3 of all Swedish hospitals.2 The concept has also spread to many other European countries.3 This model of care focuses on early follow-up after hospitalisation with symptom evaluation, optimised treatment, patient education and psycho-social support. The care is nurse-led with medical support by cardiologists with a special interest in patients with heart failure and it is most often situated in an outpatient clinic.
Follow-up at heart failure clinics have been evaluated in three Swedish randomised controlled trials,2 but the results of these studies were not addressed in the discussion by Schaufelberger et al.1 Two of the studies4,5 showed effects on reduced morbidity. Cline et al.4 found prolonged time to re-admission in patients followed up at the nurse-led outpatient clinic and a trend towards reduced number of admissions and days in hospital and health care costs.4 Strömberg et al.5 additionally showed that nurse-led follow-up at an outpatient heart failure clinic after hospitalisation improved survival and self-care behaviour in patients with heart failure and reduced the number of events (death/re-admission). The third study by Ekman et al.6 was neutral with no difference in admissions, days in hospital or survival between usual care and nurse-led follow-up, but in this study the drop-out rate was high and 29% of the patients in the intervention group did not attend the heart failure clinic as planned.
Based on the epidemiological data provided by Schaufelberger et al.1 and data from RCT trials evaluating heart failure clinics,4,5 it seems likely that the structured follow-up with symptom evaluation, optimised treatment, patient education and psychosocial support provided at the Swedish heart failure clinics have played an important role in reducing mortality and hospitalisation rates for heart failure during the last decades.
Footnotes
"Decreasing one-year mortality and hospitalisation rates for heart failure in Sweden. Data from the Swedish hospital discharge registry 1988 to 2000" published in Eur. Heart J. 25(4):300–7
References
- Schaufelberger M, Swedberg K, Köster M et al. Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000. Eur. Heart J. 2004;25:300–307.
[Abstract/Free Full Text] - Strömberg A, M
rtensson J, Fridlund B et al. Nurse-led heart failure clinics in Sweden. Eur. J. Heart Fail. 2001;3:139–144.[CrossRef][Web of Science][Medline]
- Jaarsma T, Strömberg A. Heart failure clinics in Europe. Prog. Cardiovasc. Nurs. 2000;15:67–68 72.[Medline]
- Cline C, Israelsson B, Willenheimer R et al. Cost effective management programme for heart failure reduces hospitalisation. Heart. 1998;80:442–446.
[Abstract/Free Full Text] - Strömberg A, Mrtensson J, Fridlund B et al. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure. Results from a prospective, randomised study. Eur. Heart J. 2003;24:1014–1023.
[Abstract/Free Full Text] - Ekman I, Andersson B, Ehnfors M et al. Feasibility of a nurse-monitored, outpatient-care programme for elderly patients with moderate-to-severe, chronic heart failure. Eur. Heart J. 1998;19:1254–1260.
[Abstract/Free Full Text]
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