Heart Failure, Congestive
Conditions
Keywords
beta-Adrenergic Blockers, Disease Management
Brief summary
The purpose of our study was to determine if a strategy of starting a heart medication (Beta-blocker) before patients leave the hospital and then being seen by a nurse manager would reduce subsequent hospitalizations compared to usual care. Hypothesis: A nurse-directed heart failure management program with inpatient initiation of beta blockers will improve health outcomes in a vulnerable, predominantly Hispanic and African American population.
Detailed description
Heart failure is a leading cause of death and hospitalization in the US. Designing practical approaches to improving heart failure care is therefore a national health priority. One retrospective study suggested that patients taking beta-blockers while hospitalized for heart failure had a lower risk of rehospitalization at 6-months. One prospective study suggested that starting beta blockers among hospitalized heart failure patients is safe and improves compliance. However, improved outcomes of this approach have not been prospectively demonstrated. Comparison: Inpatient initiation of the beta-blocker carvedilol coupled with outpatient follow-up with a nurse manager was compared to usual care by internists and cardiologists.
Interventions
DRUGcarvedilol plus nurse management
Sponsors
Denver Health and Hospital Authority
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
0 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* primary hospitalization with heart failure and LVEF \< 40% * patient informed consent has been obtained * absence of pulmonary congestion * age \> 18 years
Exclusion criteria
* End-stage renal or hepatic disease * Acute myocardial infarction as primary diagnosis during index hospitalization * Life-expectancy \< 6-months * Contraindication to beta blocker use * Current beta-blocker therapy * Planned bypass or valve surgery during index hospitalization
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Primary outcome: heart failure hospitalizations, time to death or hospitalization | — |
Secondary
| Measure | Time frame |
|---|---|
| left ventricular ejection fraction and volume in systole and diastole | — |
| beta-blocker utilization/adherence | — |
| new york heart association functional class | — |
Countries
United States
Outcome results
None listed