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Evidence-based chronic heart-failure management programmes: reality or myth?
  1. A Driscoll1,
  2. L Worrall-Carter2,
  3. D L Hare3,
  4. P M Davidson4,
  5. B Riegel5,
  6. A Tonkin1,
  7. S Stewart6
  1. 1Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  2. 2Director of Nursing Research Centre, Australian Catholic University, Melbourne, Australia
  3. 3Department of Cardiology, University of Melbourne, Melbourne, Australia
  4. 4Curtin Health Innovation Research Institute, Curtin University, Sydney, Australia
  5. 5School of Nursing, University of Pennsylvania, Pennsylvania, USA
  6. 6Preventative Cardiology, Baker Institute, Melbourne, Australia
  1. Correspondence to Professor Simon Stewart, Preventative Cardiology, Baker Heart Research Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia; simon.stewart{at}baker.edu.au

Abstract

Background Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF).

Objective To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes.

Design A prospective cross-sectional survey was used to conduct a national audit.

Setting Community setting of CHF-MPs for patients postdischarge.

Sample All CHF-MPs operating during 2005–2006 (n=55). Also 10–50 consecutive patients from 48 programmes were recruited (n=1157).

Main outcome measures (1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes.

Results Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26–260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), β-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%).

Conclusion CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.

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Footnotes

  • Funding AD was supported by an NHMRC Postgraduate scholarship, and this research was supported by National Heart Foundation of Australia Grant-in-aid.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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