Randomised controlled trial of specialist nurse intervention in heart failure

Abstract

Abstract Objectives: To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure. Design: Randomised controlled trial. Setting: Acute medical admissions unit in a teaching hospital. Participants: 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year. Main outcome measures: Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure. Results: 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96).Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051). Conclusions: Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure. What is already known on this topic Studies have suggested that nurse intervention may reduce readmission in patients with heart failure What this study adds Home based intervention from nurses reduces readmissions for worsening heart failure Regular contact to review treatment and patient education are likely to contribute to this effect