title: A nurse-based strategy reduces heart failure morbidity in patients admitted for acute decompensated heart failure in Brazil: the HELEN-II clinical trial.
abstract: OBJECTIVE
  Home-based interventions for heart failure (HF) patients might be particularly effective in middle-income countries, where social, cultural, and economic constraints limit the effectiveness of HF treatment outside the hospital environment.
  
  
  RESULTS
  HELEN-II was a randomized clinical trial conducted in Brazil designed to evaluate the clinical efficacy of a nurse-based strategy, started after discharge following an acute decompensated HF (ADHF) admission. HELEN-II compares the efficacy of home visits and telephone reinforcement (n = 123) with that of the conventional strategy, which is based on medical follow-up (n = 129). The primary outcome was a composite endpoint of a first visit to the emergency department (≤ 24 h), a hospital readmission (> 24 h), or all-cause death, assessed during the first 6 months of follow-up. Most enrolled subjects were middle-aged (62 ± 13 years) males (63%) in NYHA functional class II-III (84%) with severe LV dysfunction (mean LVEF 29.6 ± 9%). The primary composite endpoint was decreased by 27% in the interventional group (relative risk 0.73; 95% confidence interval 0.54-0.99; P = 0.049). At the end of follow-up, the rate of use of the standard-of-care HF medications was similar in both groups, except for the higher use of furosemide in the interventional group. Also, HF knowledge and self-care were significantly increased in the interventional group.
  
  
  CONCLUSIONS
  A post-discharge, nurse-led management strategy significantly decreases the morbidity of ADHF patients in the public health system of a developing middle-income country.
authors.affiliation: Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Instituto de Cardiologia-Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil.
authors.forename: Emiliane Nogueira
authors.initials: EN
authors.lastname: de Souza
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Rohde
authors.forename: Karen Brasil
authors.initials: KB
authors.lastname: Ruschel
authors.forename: Cláudia Mota
authors.initials: CM
authors.lastname: Mussi
authors.forename: Luis
authors.initials: L
authors.lastname: Beck-da-Silva
authors.forename: Andréia
authors.initials: A
authors.lastname: Biolo
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
authors.forename: Eneida Rejane
authors.initials: ER
authors.lastname: Rabelo-Silva
mesh_terms: D000208:Acute Disease; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000451:nursing* / Q000503:physiopathology; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010359:Patient Readmission / Q000639:trends; D057184:Practice Patterns, Nurses'; D012648:Self Care / Q000592:standards*; D013318:Stroke Volume / Q000502:physiology*
keywords: Heart failure; Home visit; Hospital readmission; Nursing; Self-care