title: Heart failure programmes in countries with a primary care-based health care system. Are additional trials necessary? Design of the DEAL-HF study.
abstract: BACKGROUND
  Several randomised studies of heart failure (HF) management programmes in the United States, Australia and Europe have shown a considerable reduction in hospitalisation rates for HF. In this article, a comprehensive review of these studies will be provided and their applicability to countries, with a primary care-based healthcare system, will be discussed. In addition, the design of the Deventer-Alkmaar HF Project (DEAL-HF), a randomised study of the effect of a nurse and physician-directed intervention over 1 year in The Netherlands, will also be presented.
  
  
  OBJECTIVE
  To discuss the applicability of the results of available studies on heart failure management programmes to countries with well-structured primary care facilities and to determine whether additional trials should be conducted in these countries.
  
  
  METHODS
  We performed a literature search in PubMed. In a review of the available studies, essential methodological aspects, in particular, the population involved, the sample size, follow-up period, setting, type of intervention, and the outcome parameters, are discussed critically. Also, the applicability of these studies to countries with a primary care-based healthcare system and easy access to medical care is evaluated.
  
  
  CONCLUSIONS
  Applicability of the results of the available studies on the efficacy of heart failure management programmes to countries with a primary care-based health care system is doubtful. An efficacy trial in a country with a well-established primary care-based healthcare system, such as The Netherlands, is due to report soon (DEAL-HF).
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. P.Bruggink@dz.nl
authors.forename: Pieta W F
authors.initials: PW
authors.lastname: Bruggink-André de la Porte
authors.forename: Dirk J A
authors.initials: DJ
authors.lastname: Lok
authors.forename: Jan
authors.initials: J
authors.lastname: van Wijngaarden
authors.forename: Jan H
authors.initials: JH
authors.lastname: Cornel
authors.forename: Dian
authors.initials: D
authors.lastname: Pruijsers-Lamers
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D005060:Europe; D006297:Health Services Accessibility; D006302:Health Services Research; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D009426:Netherlands; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D016896:Treatment Outcome