Bridging the gap in heart failure prevention: rationale and design of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study.
OBJECTIVE
The primary objective of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study is to develop a programme of care that cost-effectively prevents the development of chronic heart failure (CHF). Methods NIL-CHF is a randomized controlled trial of a hybrid, home- and clinic-based, nurse-led multidisciplinary intervention targeting hospitalized patients at risk of developing CHF. A target of 750 patients aged >/=45 years will be exposed to usual post-discharge care or the NIL-CHF intervention. The composite primary endpoint is all-cause mortality or CHF-related admission during 3-5 years of follow-up. After 12 months recruitment, approximately 300 eligible patients (40% of target) have been randomized. Overall, 73% are male and the mean age is 65 +/- 10 years. The most common antecedents for CHF thus far are hypertension (70%, 95% CI, 64-75%), coronary artery disease (51%, 95% CI, 31-41%), and type 2 diabetes (26%, 95% CI, 21-31%), whereas 76% (95% CI, 69-82%) of patients have diastolic dysfunction, 29% (95% CI, 23-36%) left ventricular hypertrophy, 71% (95% CI, 64-78%) mitral valve dysfunction, and 7% (95% CI, 4-12%) have a left ventricular ejection fraction </=45%.


CONCLUSIONS
As one of the largest randomized studies of its kind, NIL-CHF will ultimately provide important insights into the potential to prevent CHF via prolonged and intensive disease management.
Carrington
Melinda J
MJ
Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, VIC 8008, Australia.
Stewart
Simon
S
D000368:Aged; D002908:Chronic Disease; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D012107:Research Design; D016019:Survival Analysis