title: Impact of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) randomized controlled study.
abstract: OBJECTIVE
  The aim of this study was to determine the effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in individuals at risk of developing de novo chronic heart failure (CHF).
  
  
  RESULTS
  A pragmatic, single-centre (tertiary-referral hospital with specialist cardiological services), open-label, randomized controlled trial with blinded endpoint adjudication was carried out. In total, 624 cardiac inpatients (66 ± 11 years, 71% male, and 70% with CAD) were randomly allocated (1:1) to standard care or the study intervention. The intention-to-treat cohort comprised 310 standard care and 301 intervention participants. During 51.0 ± 8.2 months follow-up, 38/310 (12%) standard care [mean event-free survival 1865 days, 95% confidence interval (CI) 1817-1913 days] vs. 41/301 (14%) intervention participants (1855 days, 95% CI 1804-1906 days) experienced the primary composite endpoint of de novo CHF hospitalization or all-cause mortality (P = 0.574). Although there were no statistically significant differences in the rate of cardiovascular-related and emergency hospitalizations, the NIL-CHF (Nurse-led Intervention for Less Chronic Heart Failure) group accumulated 478 (0.214 ± 0.70 vs. 0.095 ± 0.284 days/participant/month; P = 0.052) and 1097 fewer days of hospital stay (0.391 ± 1.80 vs. 0.199 ± 0.47 days/participant/month; P = 0.023), respectively, compared with standard care. The intervention group also showed better cardiac recovery on echocardiography at 3 years [81/226 (35.8%) vs. 56/225 (24.9%), odds ratio 1.44, 95% CI 1.08-1.92, P = 0.011].
  
  
  CONCLUSIONS
  Relative to a high level of standard care, the NIL-CHF intervention was ineffective in preventing CHF and rehospitalization. On the other hand, it was associated with reduced hospital stay and improved cardiac function over the long term.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (No. 12608000022369).
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Yih-Kai
authors.initials: YK
authors.lastname: Chan
authors.affiliation: Non-intervention Cardiology, Western Health, Melbourne, Australia.
authors.forename: Chiew
authors.initials: C
authors.lastname: Wong
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Garry
authors.initials: G
authors.lastname: Jennings
authors.affiliation: Centre for Applied Health Economics & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Scuffham
authors.affiliation: University of South Australia, Adelaide, Australia and Centre for Research Excellence in Chronic Disease Prevention, James Cook University, Cairns, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
authors.forename: Melinda
authors.initials: M
authors.lastname: Carrington
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D002908:Chronic Disease; D019468:Disease Management; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000517:prevention & control*; D006701:Home Nursing; D006760:Hospitalization; D006792:House Calls; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010359:Patient Readmission; D055502:Secondary Prevention / Q000379:methods*
keywords: Cardiac dysfunction; Multidisciplinary care; Nurse-led; Secondary prevention