European Heart Journal Advance Access originally published online on December 15, 2004
European Heart Journal 2005 26(3):314-315; doi:10.1093/eurheartj/ehi081
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European Heart Journal vol. 26 no. 3 © The European Society of Cardiology 2004; all rights reserved.
COACHes, players, and heart failure teams: reply
Department of Cardiology B
The Heart Centre
Blegdamsvej 9
Rigshospitalet DK-2100
Copenhagen Ø, Denmark
Tel: +45 35 45 24 41
Fax: +45 39 76 01 07
E-mail address: finng{at}dadlnet.dk
Department of Cardiology
London Health Services Centre
London, Ontario
Canada
In response to our discussion of outpatient heart failure (HF) management,1 Jaarsma and Veldhuisen2 very appropriately draw attention to the ongoing COACH study. The COACH study is an ambitious and important ‘dose–response’ study, which will answer some of the critical questions presently troubling the designers of HF management programmes. The study should provide information about how much nurse-directed intervention is needed to optimize outpatient HF management and may give insight to the relative importance of specific components of care programmes in HF, such as the use of home visits. However, it remains critical that the specific components of care in the study are accurately defined and monitored such that others can duplicate them. This has generally been a major problem in many preceding studies of multidisciplinary intervention in outpatient HF management. The results of the COACH study, when available, will be most easily generalized to healthcare systems very similar to that of the Netherlands. The ‘care as usual’ arm of the study, in particular, may be different from what ‘usual care’ represents in other healthcare systems. Accessibility to cardiologists, for instance, may vary considerably between countries or even regions.3 Hence, the feasibility of any programme may differ countries, and similar trials may need to be conducted in a wide variety of healthcare delivery systems building on the knowledge gained from COACH.
As discussed in our review, we believe that, if this trial or others are positive for different approaches, it remains of critical importance that healthcare providers implement the new proven strategies with concomitant quality assurance assessments as the process of care is not as easily packaged as a drug and many sources of variability can intrude. To accomplish this, we encourage healthcare regions and countries to consider national registries to monitor the effectiveness of HF provision of care based on implementation of new clinical trial evidence. Together with well-performed randomized clinical trials of care delivery, data from such registries would help refine the design of HF management programmes and optimize implementation in individual healthcare systems. We look forward to the results of COACH and the appearance of many more skilled HF coaches and players in different countries.
References
- Gustafsson F, Arnold JMO. Heart failure clinics and outpatient management—review of the evidence and call for quality assurance. Eur Heart J 2004;25:1596–1604.
[Abstract/Free Full Text] - Jaarsma T, van der Wal MHL, Hogenhuis J et al. Design and methodology of the COACH study: a multicenter randomized Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. Eur J Heart Fail 2004;6:227–233.[CrossRef][ISI][Medline]
- Cleland JGF, Swedberg K, Follath F et al. The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003;24:442–463.
[Abstract/Free Full Text]
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