Congestive Heart Failure (CHF), Systolic Dysfunction
Conditions
Keywords
Congestive heart failure, nurse management, effectiveness trial, quality improvement, minority communities, disease management
Brief summary
For congestive heart failure (CHF) patients with systolic dysfunction, a randomized controlled trial compared nurse-based disease management to address problems in patient and clinician management with usual care for effects on hospitalization and functioning among ethnically-diverse patients in ambulatory practices.
Detailed description
Congestive heart failure (CHF) disproportionately afflicts Black and elderly people, and is a leading cause of hospitalization \> 65 years. Although effective therapies can improve functioning and survival in patients with systolic dysfunction, many may not be receiving the full benefit of existing knowledge, including counseling on self-management and appropriate doses of medications. Patients play a critical role in managing a chronic condition such as CHF, but may not have the skills to do so. Clinicians may not provide counseling or medications consistent with evidence-based guidelines. Systematic reviews of clinical-behavior change have suggested that interventions targeted to specific problems are more likely to be successful. Based on shortfalls identified in patient self-management and clinical care in Harlem, a predominately non-white area in northern Manhattan, we tailored a nurse-management intervention to address the problems documented, and evaluated its effectiveness in a randomized controlled trial. This trial among primarily-minority patients addresses important gaps in this literature: the study targeted problems documented among CHF patients in Harlem, enrolled patients from ambulatory practices, randomly assigned patients between nurse-management and usual care, and evaluated their subsequent health-related outcomes. Hypothesis: the nurse-management program would result in nurse patients' having fewer hospitalizations and reporting better functioning.
Interventions
BEHAVIORALNurse-management
bilingual nurses counseled patients on diet, medication adherence, and self-management of symptoms through an initial visit and regularly scheduled follow-up telephone calls and facilitated evidence-based changes to medications in discussions with patients' clinicians.
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Icahn School of Medicine at Mount Sinai
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* • adults \>18 years, * systolic dysfunction documented on a cardiac test (echocardiography, radionuclide ventriculography, myocardial stress sestamibi/thallium testing, or left-heart catheterization), * English- or Spanish-speaking, * community-dwelling at enrollment, and * current patient in a general medicine, geriatrics, or cardiology clinic or office at a participating site.
Exclusion criteria
* • medical conditions that prevented a patient's interacting with the nurse, including blindness, deafness, and cognitive impairment; * medical conditions that required individualized management that might differ from standard protocol, namely pregnancy, renal dialysis, and terminal illness; and * procedures that corrected systolic dysfunction, such as heart transplantation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Short Form 12 questionnaire | 12 months | self-reported physical functioning as measured by the physical component score on the Short Form 12 questionnaire |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of hospitalizations | 12 months | number of hospitalizations in 12 month period |
| Minnesota Living with Heart Failure Questionnaire | 12 months | self-reported physical functioning as measured by the physical component score on the Minnesota Living with Heart Failure Questionnaire |
| Number of deaths | 12 months | deaths measured by the reporting of death by patient family or recording in the National Death Index |
Countries
United States
Outcome results
None listed