Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: Does more equal less?

Andrea Driscoll, Andrew Tonkin, Andrew Stewart, Linda Worrall-Carter, David R. Thompson, Barbara Riegel, David L. Hare, Patricia M. Davidson, Christine Mulvany, Simon Stewart

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Abstract

Aims and objectives: To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS). Background: The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes. Design: Prospective cohort study of patients participating in heart failure programmes. Method: Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined. Results: Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer. Conclusion: High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months. Relevance to clinical practice: The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.

Original languageEnglish
Pages (from-to)1629-1638
Number of pages10
JournalJournal of Clinical Nursing
Volume22
Issue number11-12
DOIs
Publication statusPublished - 1 Jun 2013
Externally publishedYes

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Keywords

  • Disease management
  • Heart failure
  • Heart failure programmes
  • Quality score

Cite this

Driscoll, A., Tonkin, A., Stewart, A., Worrall-Carter, L., Thompson, D. R., Riegel, B., Hare, D. L., Davidson, P. M., Mulvany, C., & Stewart, S. (2013). Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: Does more equal less? Journal of Clinical Nursing, 22(11-12), 1629-1638. https://doi.org/10.1111/jocn.12073