ESC heart failure · 2025
Nurse-coordinated multidisciplinary comprehensive heart failure management programme: A propensity-matched trial.
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Chan Cecilia Miu-Ching, Li Polly Wai-Chi, Lee Derek Pok-Him, Fong Esmond Yan-Hang, Ng Ivy Sin-Yee, Chiu Samantha Ki-Man, Fok Clara Woon-Shan, Li Frederick Kin-Wa, Lee Shirley Ka-Wai, Ho Karen K Y, Leung Wilson Y S, Chan Cathy Cheuk-Sum, Tsang Cindy Yiu-Ning, Lee Michael Kang-Yin
Аннотация
AIMS: Despite therapeutic advancements, the prognosis of heart failure (HF) remains poor, with high rates of mortality and readmission, particularly following a HF exacerbation. This study aimed to evaluate the effects of a nurse-coordinated multidisciplinary comprehensive HF management programme on HF patients.
METHODS AND RESULTS: This retrospective cohort study involved patients admitted for acute HF exacerbation at a regional hospital in Hong Kong. We established two patient cohorts: the control cohort, recruited between January and December 2021, received standard care, while the programme cohort, recruited from October 2022 to December 2023, participated in a comprehensive programme. This programme included multidisciplinary ward rounds, early initiation of guideline-directed medical therapy (GDMT), discharge education, post-discharge transitional care and cardiac rehabilitation. The primary outcome was the composite endpoint of all-cause mortality and HF-related readmission at 6 months. Secondary endpoints included HF-related readmission and all-cause mortality. We also assessed patient satisfaction and health-related quality of life (HRQoL) in the programme cohort. The study included 732 patients, 24.0% female, 81.6% with HFrEF, mean age of 67.9 ± 13.2 years. After matching for age, sex and type of HF, 366 patients were allocated to each cohort. The programme cohort demonstrated significantly lower rates of the composite endpoint [12.0% vs. 38.0%, adjusted hazard ratio (aHR) = 0.26, 95% confidence interval (CI) = 0.19-0.37, P < 0.001]) and HF-related readmissions (10.1% vs. 25.4%, aHR = 0.36, 95% CI = 0.24-0.52, P < 0.001) compared with the control cohort. All-cause mortality was also significantly reduced (4.4% vs. 18.3%, aHR = 0.22, 95% CI = 0.13-0.38, P < 0.001). Improvements in HRQoL and high patient satisfaction were noted in the programme cohort.
CONCLUSIONS: The nurse-coordinated comprehensive HF management programme significantly reduced readmissions and mortality, with consistent benefits across different subgroups. Further research is needed to confirm these benefits and explore mechanisms.
METHODS AND RESULTS: This retrospective cohort study involved patients admitted for acute HF exacerbation at a regional hospital in Hong Kong. We established two patient cohorts: the control cohort, recruited between January and December 2021, received standard care, while the programme cohort, recruited from October 2022 to December 2023, participated in a comprehensive programme. This programme included multidisciplinary ward rounds, early initiation of guideline-directed medical therapy (GDMT), discharge education, post-discharge transitional care and cardiac rehabilitation. The primary outcome was the composite endpoint of all-cause mortality and HF-related readmission at 6 months. Secondary endpoints included HF-related readmission and all-cause mortality. We also assessed patient satisfaction and health-related quality of life (HRQoL) in the programme cohort. The study included 732 patients, 24.0% female, 81.6% with HFrEF, mean age of 67.9 ± 13.2 years. After matching for age, sex and type of HF, 366 patients were allocated to each cohort. The programme cohort demonstrated significantly lower rates of the composite endpoint [12.0% vs. 38.0%, adjusted hazard ratio (aHR) = 0.26, 95% confidence interval (CI) = 0.19-0.37, P < 0.001]) and HF-related readmissions (10.1% vs. 25.4%, aHR = 0.36, 95% CI = 0.24-0.52, P < 0.001) compared with the control cohort. All-cause mortality was also significantly reduced (4.4% vs. 18.3%, aHR = 0.22, 95% CI = 0.13-0.38, P < 0.001). Improvements in HRQoL and high patient satisfaction were noted in the programme cohort.
CONCLUSIONS: The nurse-coordinated comprehensive HF management programme significantly reduced readmissions and mortality, with consistent benefits across different subgroups. Further research is needed to confirm these benefits and explore mechanisms.