Copyright © 2004 by the European Society of Cardiology.
Letter to Editor
Searching for dose-response in heart failure clinics: Reply
Department of Cardiology, Linkoping University Hospital, 581 85 Linkoping, Sweden
* Correspondence to: Tel: +46-13 227762; Fax: +46-13-222224
E-mail address: annst{at}imv.liu.se
Nurse-led heart failure clinics have been used in clinical practice in Sweden for more than 10 years and the concept has spread to many other European countries.1This model of care focuses on early follow-up after hospitalization with symptom monitoring, optimized treatment, patient education and psychosocial support. The care is nurse-led with medical support by cardiologists with special interest in patients with heart failure. Nurse-led follow-up of patients with heart failure has been evaluated in several studies and the majority of the studies have shown a decrease in hospitalization and recently we also showed a decrease in mortality.2It has been debated which of the components in the nurse-led heart failure follow-up is most important and effective, but none of the present studies has been designed to answer this question. However, it might be more relevant to consider this type of follow-up as a concept of care composed of several components with synergism instead of believing that just one single component could be enough to improve outcomes such as survival, morbidity and quality of life.
The description of the nurse-led intervention in our study was as detailed as possible in order to provide data on how the patients were treated and followed-up. Due to the design of the study, we cannot attribute the success of this follow-up to one particular component of the intervention. However, the concept as a whole led to improved self-care in the patients in the intervention group in terms of better adherence to treatment, more effective monitoring and management of symptoms and this was probably important for the decrease in mortality and morbidity. This is further underlined by the fact that the prescribed (not necessary followed) treatment with ACE-inhibitors and beta-blockers did not differ that much between patients in the intervention and in the control group. At baseline and after 12 months there was no difference in the prescription of ACE-inhibitors and beta-blockers between the groups. After 3 months a significant larger amount of patients in the intervention group had reached the target dose of the ACE-inhibitor, but there was no difference in the use of beta-blockers.2The intensity of the intervention was individualised in our study, ranging from one to eight visits to the heart failure clinics.2An individualized intervention has several advantages for the patient as well as for the health economy. From both research and clinical experience we know that the heart failure population is a heterogeneous group and the patients have a different need for follow-up after hospitalization. If the goal is to provide patient focused and cost effective care it should be the patients needs and status that determine the number of follow up visits at a nurse-led heart failure clinic rather than a predetermined plan of care with low or high intensity that treats all patients in a standardized way.
References
- 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][ISI][Medline]
- 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(11):1014–1023.
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