Evaluation of a nurse-led intervention program in heart failure: A randomized trial

Effectiveness of nurse-led heart failure clinic: A systematic review

Objectives

Heart failure is a stage of various cardiovascular diseases and constitutes a growing major public health problem worldwide. Nurse-led heart failure clinics play an important role in managing heart failure. All nurse-led heart failure clinic services are clinic-based. We conducted a systematic review to describe the contents and impact of nurse-led heart failure clinics.

Methods

A review of nurse-led heart failure clinic research was undertaken in PubMed, Embase, Web of Science, and Cochrane Library. The search was initially conducted on October 23, 2022 and updated on November 21, 2023. Articles were appraised using the Joanna Briggs Institute Appraisal criteria by two independent reviewers. This review was registered on PROSPERO (CRD42022352209).

Results

Twelve articles were included in this systematic review. The nurse-led heart failure clinic contents were: medication uptitration, educational counselling, evidence-based transitional care, psychosocial support, physical examination and mental well-being assessment, therapy monitoring and adjustment, follow-up, and phone consultations. Most studies reported largely positive clinical outcomes in nurse-led heart failure clinics. Four studies examined the quality of life and reported conflicting results; four studies examined medication titration efficacy, and the results were generally positive. Only two studies examined cost-effectiveness.

Conclusions

Nurse-led heart failure clinics have shown a largely positive impact on patient outcomes, quality of life, and medication titration efficacy. More randomised controlled trials and other studies are needed to obtain more robust conclusions.

Outcomes of Patient Education in Nurse-led Clinics: A Systematic Review

Introduction

Patient education is an independent role of nurses performed in nurse-led clinics (NLCs). The measurement of patient education outcomes validates whether nursing educational interventions have a positive effect on patients, which helps determine whether changes in care are needed. Standardized nursing terminologies facilitate the evaluation of educational outcomes. We aimed to explore the outcomes of patient education in NLCs based on the Nursing Outcome Classification (NOC) system.

Methods

The review was conducted according to PRISMA guidelines. We searched "Medline", "Embase", "Web of Science", and "Scopus" databases for articles published between 2000 and 2022. Based on the search strategy, 1157 articles were retrieved from PubMed, Scopus, Web of Science, and Embase databases. After excluding the duplicates, 978 articles were appraised. 133 articles remained after reading the titles and abstracts of the articles. In the next step, the articles were evaluated regarding methodology, research population, and exclusion criteria, after which 112 articles were omitted, and finally, 21 articles were included in the full-text review. We assessed all included studies using the Quality Assessment of Controlled Intervention Studies checklist.

Results

A total of 21 randomized controlled trials met the inclusion criteria. "Physiologic health", "functional health", "psychosocial health", "health knowledge and behavior", and "perceived health" were the domains of nursing outcomes investigated as Patient Education Outcomes in NLCs.

Conclusion

Most of the outcomes were linked to lifestyle-related chronic diseases and, further studies are needed to determine the effects of patient education provided in NLCs in terms of family/society health outcomes.

Multicomponent integrated care for patients with chronic heart failure: systematic review and meta-analysis

To investigate the effectiveness of multicomponent integrated care on clinical outcomes among patients with chronic heart failure. We conducted a meta-analysis of randomized clinical trials, published in English language from inception to 20 April 2022, with at least 3-month implementation of multicomponent integrated care (defined as two or more quality improvement strategies from different domains, viz. the healthcare system, healthcare providers, and patients). The study outcomes were mortality (all-cause or cardiovascular) and healthcare utilization (hospital readmission or emergency department visits). We pooled the risk ratio (RR) using Mantel-Haenszel test. A total of 105 trials (n = 37 607 patients with chronic heart failure; mean age 67.9 ± 7.3 years; median duration of intervention 12 months [interquartile range 6-12 months]) were analysed. Compared with usual care, multicomponent integrated care was associated with reduced risk for all-cause mortality [RR 0.90, 95% confidence interval (CI) 0.86-0.95], cardiovascular mortality (RR 0.73, 95% CI 0.60-0.88), all-cause hospital readmission (RR 0.95, 95% CI 0.91-1.00), heart failure-related hospital readmission (RR 0.84, 95% CI 0.79-0.89), and all-cause emergency department visits (RR 0.91, 95% CI 0.84-0.98). Heart failure-related mortality (RR 0.94, 95% CI 0.74-1.18) and cardiovascular-related hospital readmission (RR 0.90, 95% CI 0.79-1.03) were not significant. The top three quality improvement strategies for all-cause mortality were promotion of self-management (RR 0.86, 95% CI 0.79-0.93), facilitated patient-provider communication (RR 0.87, 95% CI 0.81-0.93), and e-health (RR 0.88, 95% CI 0.81-0.96). Multicomponent integrated care reduced risks for mortality (all-cause and cardiovascular related), hospital readmission (all-cause and heart failure related), and all-cause emergency department visits among patients with chronic heart failure.

Current state of knowledge and information sharing among home healthcare professionals involved in heart failure management

BACKGROUND

The current state of knowledge related to disease management of heart failure (HF) and information coordination practices provided by non-physician healthcare professionals such as nurses and therapists working at home-visit nursing stations in Japan are not well known.

METHODS

A questionnaire survey of healthcare professionals working at home-visit nursing stations was conducted in Kochi Prefecture. Data collected from 151 nurses and therapists were analyzed.

RESULTS

Regarding the basic characteristics of the respondents, the majority were in their 30s and 40s, and approximately 75 % were nurses. In terms of HF knowledge, 53.7 % of respondents said that they "knew" about the New York Heart Association classification. A total of 40.0 % of respondents said that they were "aware of the existence of the HF handbook", and only 29.3 % of respondents said that they "knew" the classification of HF stages. When they were asked about their level of satisfaction related to all medical information provided by the hospital and hospital wards, no one was "very satisfied", and the most common response (66.2 %) was "not very satisfied". In the essential medical information that respondents wanted to obtain from hospitals and hospitals wards for managing HF patients at home, "medication at discharge", "current medical history", "fluid intake and restrictions", "symptoms, signs, and response to exacerbation", and "ideal body weight" were the top five contents.

CONCLUSION

In the cross-sectional study targeted healthcare professionals working at home-visit nursing stations in Kochi Prefecture, the current state of knowledge related to HF and information coordination practices among healthcare professionals were not fully satisfactory in HF management. It is necessary to increase educational opportunities regarding HF for them and further promote information sharing.

Roles of Nursing in the Management of Geriatric Cardiovascular Diseases

The nursing field occupies the largest secion of the cardiovascular healthcare services. Despite this, the roles of nursing within the cardiovascular healthcare system has not been well displayed. The authors searched PubMed and Embase (between January 1, 1950, and June 17, 2021) and created a narrative review of recent publications regarding the role of nursing in the management of geriatric cardiovascular disease (CVD). Patients with geriatric CVD, which includes mainly myocardial ischemia and heart failure, were enrolled. Nursing can improve the outcomes of myocardial ischemia and heart failure. It plays a pivotal role in the recovery, rehabilitation, and outcomes of geriatric CVD, especially for chronic heart diseases. Taken together, this paper compiled is focused on the current status of cardiovascular nursing and may facilitate future treatment and rehabilitation in geriatric CVD.

The effect of nurse-led interventions on re-admission and mortality for congestive heart failure: A meta-analysis

BACKGROUND

The European Society of Cardiology guidelines recommend the implementation of nurse-led heart failure programs to achieve optimal management of patients with congestive heart failure (CHF). In this analysis, we aimed to systematically show the impact of nurse-led interventions (NLI) on re-admission and mortality in patients with CHF (reduced ejection fraction).

METHODS

Publications reporting the impact of NLI on readmission and mortality in patients with CHF were carefully searched from electronic databases. Rehospitalization and mortality were the endpoints. For this analysis, the latest version of the RevMan software was used. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent data following analysis.

RESULTS

A total number of 3282 participants with CHF were included in this analysis. A total of 1571 patients were assigned to the nurse-led intervention group whereas 1711 patients were assigned to the usual care group. The patients had a mean age ranging from 50.8 to 80.3 years. Male patients varied from 27.3% to 73.8%. Comorbidities including hypertension (24.6%-80.0%) and diabetes mellitus (16.7%-59.7%) were also reported. Patients had a mean left ventricular ejection fraction varying from 29.0% to 61.0%. Results of this current analysis showed that rehospitalization (RR: 0.81, 95% CI: 0.74-0.88; P = .00001) and mortality (RR: 0.69, 95% CI: 0.56-0.86; P = .0009) were significantly lower among CHF patients who were assigned to the nurse-led intervention. Whether during a shorter (3-6 months) or a longer (1-2 years) follow up time period, rehospitalization for shorter [(RR: 0.73, 95% CI: 0.65-0.82; P = .00001) vs for longer (RR: 0.81, 95% CI: 0.72-0.91; P = .0003) respectively] and mortality for shorter [(RR: 0.55, 95% CI: 0.38-0.80; P = .002) vs longer follow up time period (RR: 0.76, 95% CI: 0.58-0.99; P = .04) respectively] were significantly lower and in favor of the nurse-led interventional compared to the normal care group.

CONCLUSIONS

This systematic review and meta-analysis of randomized controlled trials showed that NLI had significant impacts in reducing the risk of rehospitalization and mortality in these patients with CHF (reduced ejection fraction). Hence, we believe that nurse-led clinics and other interventional programs would be beneficial to patients with heart failure and this practice should, in the future be implemented to the health care system.