title: [Comparison between telephone and outpatient nursing management in patients with chronic heart failure in a large territorial area in Piedmont, Italy].
abstract: BACKGROUND
  In the last years, the increasing incidence and prevalence, the deterioration of quality of life, the high mortality and the elevated costs related to chronic heart failure represent one of the most important problems of public health care. Multidisciplinary management systems based on specialized nurses teams improve the outcome and reduce the costs of care of these patients. The aim of this study was to analyze the use for 1 year, in an urban or suburban population, of two different nurse-based management systems in addition to usual care for outpatients with congestive heart failure.
  
  
  METHODS
  We enrolled 102 patients: group A (n = 49) was followed up with a phone-nurse-based system and group B (n = 53) was followed up with a nurse ambulatory system.
  
  
  RESULTS
  An improvement in NYHA class was observed in both groups (group A: NYHA class I-II 31 to 38 patients, NYHA class III-IV 18 to 7 patients, p = 0.03; group B: NYHA class I-II 37 to 43 patients, NYHA class III-IV 16 to 6 patients, p = 0.03). An improvement was also observed in the Minnesota Living with Heart Failure Questionnaire (group A: 25 +/- 10 to 15 +/- 9; p <0.01; group B: 29 +/- 13 to 20 +/- 10; p <0.01), and in ejection fraction (group A: from 31 +/- 9 to 37 +/- 12%; p <0.01; group B: from 30 +/- 9 to 35 +/- 13%; p = 0.02). No significant differences were found between the two groups in mortality, hospital readmission, emergency room and day-hospital admissions.
  
  
  CONCLUSIONS
  Our results confirm the effectiveness of a monitoring management and educational system for heart failure patients. A phone-nurse-based system requires minor staff and has a better flexibility than a nurse ambulatory system; the latter, however, leads to a professional and human complete interaction as well as enables rapid intervention of the cardiologist in case of instability.
authors.affiliation: U.O.A. di Cardiologia, Ospedale degli Infermi, ASL TO 3, Rivoli, TO. mainardi.loredana@gmail.com
authors.forename: Loredana
authors.initials: L
authors.lastname: Mainardi
authors.forename: Ernesto
authors.initials: E
authors.lastname: Iazzolino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Asteggiano
authors.forename: Raffaella
authors.initials: R
authors.lastname: Lusardi
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
authors.forename: Luigia
authors.initials: L
authors.lastname: Sasso
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Conte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000451:nursing* / Q000628:therapy; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013689:Telephone