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European Heart Journal 2004 25(15):1369; doi:10.1016/j.ehj.2004.04.040
Copyright © 2004 by the European Society of Cardiology.
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Letter to the Editor

Many factors contribute to improved prognosis for patients with heart failure: Reply

Maria Schaufelberger, Annika Rosengren and Karl Swedberg

Department of Medicine, Sahlgrenska University Hospital/Östra, S-416 85 Göteborg, Sweden. Tel.: +46-31-3434000; fax: +46-31-259254

E-mail address: maria.schaufelberger{at}hjl.gu.se

We thank Strömberg and Dahlström for highlighting the structured clinical care programmes often used in Swedish hospitals. In our discussion, we clearly point out that we do not know why the prognosis for patients hospitalised for heart failure has improved.1 We discuss different possibilities and it is very likely that improved medical treatments of hypertension, ischaemic heart disease and heart failure, which have been demonstrated in big outcome studies, is of great importance for the beneficial results. We also discuss how to provide these treatments in a clinical setting. The evidence for benefit from special care programmes of patients with heart failure is limited but it is reasonable to believe that an organised treatment regimen is favourable as this care will help to disseminate evidence-based treatments. We referred to home-based care because it shows one extreme possibility.2 More recent findings from Sweden with a limited number of patients support the value of nurse-led clinics.3 Nurse-led clinics are also recommended in the ESC guidelines.4 However, as discussed elsewhere, we do not know why structured care may be successful.5 The content of the components of structured care would be important to assess for our understanding of the importance of this type of care.

Until now, we have reason to speculate upon the importance of this care but as Strömberg and Dahlström point out, the results are not unambiguous.

Accordingly, we do believe that nurse-led clinics are important. However, we do not know why this care may be beneficial and we do not know the relation between special care and the documented effects of medicines. Until then, each organisation has to find the optimal way to provide evidence-based treatments. In Sweden, nurse-led clinics in this context have now been established.

References

  1. Schaufelberger M et al. Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to2000. Eur. Heart J. 2004;25(4):300–307.[Abstract/Free Full Text]
  2. Stewart S, Horowitz JD. Home-based intervention in congestive heart failure: long-term implications on readmission and survival. Circulation. 2002;105(24):2861–2866.[Abstract/Free Full Text]
  3. Stromberg A et al. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. Eur. Heart J. 2003;24(11):1014–1023.[Abstract/Free Full Text]
  4. The Task Force for the Diagnosis and treatment of chronic heart failure: Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001;22(17):1527–60.
  5. Ekman I, Swedberg K. Home-based management of patients with chronic heart failure-focus on content not just form!. Eur. Heart J. 2002;23(17):1323.[Free Full Text]

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This Article
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