Impact of a nurse-led heart failure program on all-cause mortality.
BACKGROUND
Nurse-led heart failure programs (HFPs) have been shown to reduce readmissions and improve medication adherence rates. However, their impact on survival is not well demonstrated.


OBJECTIVE
The purpose of this study was to evaluate the impact of a nurse-led HFP on all-cause mortality.


METHODS
This retrospective review included 413 consecutive patients who were admitted with heart failure exacerbations in 2008 and 2009. All patients were invited to attend a nurse-led HFP; 199 (48%) patients agreed and were compared with the 214 (52%) who chose usual care. Patients were followed for all-cause mortality, which was confirmed by the national death index. Independent predictors of outcomes were identified using multivariable Cox regression.


RESULTS
Patients followed in the HFP were younger, more often men with lower ejection fraction, blood urea nitrogen, and systolic blood pressure. After a median follow-up of 15 months (range, 6-30 months), a total of 55 patients died: 14 in the HFP group (7%) compared with 41 patients (19%) in the usual care group. Participation in the HFP was independently associated with reduction in all-cause mortality (hazard ratio, 0.4; 95% confidence interval, 0.2-0.8; P = .008).


CONCLUSIONS
Our nurse-led HFP was independently associated with improved survival among patients with decompensated heart failure. Further research is required to confirm this finding.
Bassam Bdeir, MD Consultant Cardiologist and Division Head, Cardiac Clinics, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Tara Conboy, RN, BSN, MSc Nurse Supervisor, Cardiovascular Disease Management Program, Cardiac Sciences, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Abdulmajid Mukhtar, MD Consultant, Adult Cardiology Division, Cardiac Sciences, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Hafez Omer, MD Consultant, Adult Cardiology Division, Cardiac Sciences, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Raed Odeh, RGN, BSN Nurse Specialist, Cardiovascular Disease Management Program, Cardiac Clinics, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Iyad Farah, RGN, MS Nurse Specialist, Cardiovascular Disease Management Program, Cardiac Clinics, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. May Al-Khateeb, RGN Nurse Specialist, Cardiovascular Disease Management Program, Cardiac Clinics, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Alaa Tayiem, RGN Nurse Specialist, Cardiovascular Disease Management Program, Cardiac Clinics, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Alhanouf Dosari, BSc Coordinator, Clinical Departments, King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Mouaz Al Mallah, MD, MSc, FACC, FAHA, FESC Section Head, Advance Cardiac Imaging Diseas
Bassam
B
Bdeir
Tara
T
Conboy
Abdulmajid
A
Mukhtar
Hafez
H
Omer
Raed
R
Odeh
Iyad
I
Farah
May
M
Al-Khateeb
Alaa
A
Tayiem
Alhanouf
A
Dosari
Mouaz
M
Al Mallah
D000328:Adult; D000368:Aged; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000451:nursing*; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D010353:Patient Education as Topic / Q000458:organization & administration*; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D014481:United States