Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: does more equal less?

2013-02-07

Driscoll, Andrea

Tonkin, Andrew M

Stewart, Andrew

Worrall-Carter, Linda

Thompson, David R

Riegel, Barbara

Hare, David L

Davidson, Patricia M

Mulvany, Christine

Stewart, Simon

Journal Article

0000-0001-9554-6556

10.1111/jocn.12073

To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS).The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes.Prospective cohort study of patients participating in heart failure programmes.Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined.Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer.High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months.The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.

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Journal of Clinical Nursing 2013; 22(11-12): 1629-38

Journal of clinical nursing