title: Telemanagement of heart failure: a diuretic treatment algorithm for advanced practice nurses.
abstract: Thirty-three percent of patients with heart failure (HF) are readmitted to the hospital with worsening disease within 90 days of discharge. Acute decompensation accounts for nearly 50% of these admissions because of nonadherence with diet guidelines, medication regimens, or both. One way to promote adherence is through a disease management approach that can prevent HF decompensation by providing aggressive follow-up care. Within such an approach, advanced practice nurses can use a decision algorithm to implement pharmacologic and nonpharmacologic interventions. This article presents a diuretic treatment algorithm for advanced practice nurses as part of a telemanagement program. Preliminary data from the implementation of such an algorithm within an established HF program shows a decrease in hospitalizations rates and cost of care. In addition, the algorithm helps define the scope of advanced practice nursing and promotes consistency across health care sites.
authors.affiliation: Evanston Northwestern Healthcare, Northwestern University, Chicago, IL, USA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Mueller
authors.forename: Karen M
authors.initials: KM
authors.lastname: Vuckovic
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Knox
authors.forename: Randall E
authors.initials: RE
authors.lastname: Williams
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D003266:Continuity of Patient Care; D019468:Disease Management; D004232:Diuretics / Q000627:therapeutic use*; D006333:Heart Failure / Q000451:nursing / Q000628:therapy*; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010359:Patient Readmission; D017216:Telemedicine / Q000379:methods*; D014481:United States
chemical_list: D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists