title: Feasibility of evidence-based diagnosis and management of heart failure in older people in care: a pilot randomised controlled trial.
abstract: BACKGROUND
  Many older people in long-term care do not receive evidence-based diagnosis or management for heart failure; it is not known whether this can be achieved for this population. We initiated an onsite heart failure service, compared with 'usual care' with the aim of establishing the feasibility of accurate diagnosis and appropriate management.
  
  
  METHODS
  A pilot randomised controlled trial which randomised residents from 33 care facilities in North-East England with left ventricular systolic dysfunction (LVSD) to usual care or an onsite heart failure service. The primary outcome was the optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists at 6 months.
  
  
  RESULTS
  Of 399 echocardiographically-screened residents aged 65-100 years, 30 subjects with LVSD were eligible; 28 (93%) consented and were randomised (HF service: 16; routine care: 12). Groups were similar at baseline; six month follow-up was completed for 25 patients (89%); 3 (11%) patients died. Results for the primary outcome were not statistically significant but there was a consistent pattern of increased drug use and titration to optimum dose in the intervention group (21% compared to 0% receiving routine care, p=0.250). Hospitalisation rates, quality of life and mortality at 6 months were similar between groups.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility of an on-site heart failure service for older long-term care populations. Optimisation of medication appeared possible without adversely affecting quality of life; this questions clinicians' concerns about adverse effects in this group. This has international implications for managing such patients. These methods should be replicated in a large-scale study to quantify the scale of benefit.
  
  
  BACKGROUND
  ISRCTN19781227 http://www.controlled-trials.com/ISRCTN19781227
authors.affiliation: Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees TS17 6BH, UK. helen.hancock@durham.ac.uk
authors.forename: Helen C
authors.initials: HC
authors.lastname: Hancock
authors.forename: Helen
authors.initials: H
authors.lastname: Close
authors.forename: James M
authors.initials: JM
authors.lastname: Mason
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Murphy
authors.forename: Ahmet
authors.initials: A
authors.lastname: Fuat
authors.forename: Mark
authors.initials: M
authors.lastname: de Belder
authors.forename: Trudy
authors.initials: T
authors.lastname: Hunt
authors.forename: Andy
authors.initials: A
authors.lastname: Baker
authors.forename: Douglas
authors.initials: D
authors.lastname: Wilson
authors.forename: A Pali S
authors.initials: AP
authors.lastname: Hungin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies