title: Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial.
abstract: OBJECTIVE
  Patients with chronic heart failure (CHF) may be insufficiently treated pharmacologically. Recently, we presented a person-centred integrated Palliative advanced homecaRE and heart FailurE caRe (PREFER) strategy and compared it with usual care (control). Patients managed according to PREFER had improved health-related quality of life and markedly reduced hospitalisations compared with the control group. We hypothesised that these improvements may have been partly due to better drug treatments within the PREFER strategy. Thus, our aim in this study was to explore the management of drug treatments in the PREFER group compared with the control group.
  
  
  METHODS
  Doses and numbers of drugs and the number of patients receiving the target doses based on current guidelines were measured and compared between the groups at the start and finish of the study.
  
  
  RESULTS
  The percentages of ACE inhibitors (ACEIs) or mineralocorticoid receptor antagonists (MRAs) increased, while loop diuretics decreased in the PREFER arm during the study, although the differences were not significant. Beta-receptor blockers (BBs) decreased somewhat in both groups. The number of patients treated with MRAs differed the most between groups, and increased from 10 (28%) to 15 (48%) in the PREFER arm compared with 13 (35%) vs 13 (39%) in the control group. The change in patients receiving full target doses (+8 vs. +1) of the ACEIs/angiotensin receptor blockers, BBs and MRAs were significantly higher (p=0009) in the PREFER arm than in the control arm.
  
  
  CONCLUSIONS
  Person-centred integrated care of patients with severe CHF was associated with increased evidence-based drug treatments, especially MRAs.
  
  
  BACKGROUND
  NCT01304381.
authors.affiliation: Internal medicine clinic, St Göran hospital, Stockholm, Sweden. At the time of writing the article at Internal medicine clinic, Skellefteå hospital, Skellefteå, Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Markgren
authors.affiliation: Department of Nursing, Strategic Research Program in Health Care Sciences (SFO-V), "Bridging Research and Practice for Better Health", Umeå University, Umeå, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Brännström
authors.affiliation: Palliative Care Unit AHS, Skellefteå Hospital, Skellefteå, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Lundgren
authors.affiliation: Research unit, Department of Medicine, Skellefteå, Institution of Public Health and Clinical, Medicine, Umeå University, Umeå, Sweden.
authors.forename: Kurt
authors.identifier: http://orcid.org/0000-0002-0350-2132
authors.initials: K
authors.lastname: Boman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006699:Home Care Services / Q000592:standards; D064946:Hospice and Palliative Care Nursing; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D010166:Palliative Care / Q000592:standards; D018802:Patient-Centered Care / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D011788:Quality of Life
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D000451:Mineralocorticoid Receptor Antagonists
keywords: Chronic heart failure; Palliative care; Person-centred; Pharmacology