PMID- 17065182
OWN - NLM
STAT- MEDLINE
DCOM- 20070720
LR  - 20181113
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Print)
IS  - 1355-6037 (Linking)
VI  - 93
IP  - 7
DP  - 2007 Jul
TI  - Added value of a physician-and-nurse-directed heart failure clinic: results from 
      the Deventer-Alkmaar heart failure study.
PG  - 819-25
AB  - AIM: To determine whether an intensive intervention at a heart failure (HF) 
      clinic by a combination of a clinician and a cardiovascular nurse, both trained 
      in HF, reduces the incidence of hospitalisation for worsening HF and/or all-cause 
      mortality (primary end point) and improves functional status (including left 
      ventricular ejection fraction, New York Heart Association (NYHA) class and 
      quality of life) in patients with NYHA class III or IV. SETTING: Two regional 
      teaching hospitals in The Netherlands. METHODS: 240 patients were randomly 
      allocated to the 1-year intervention (n = 118) or usual care (n = 122). The 
      intervention consisted of 9 scheduled patient contacts-at day 3 by telephone, and 
      at weeks 1, 3, 5, 7 and at months 3, 6, 9 and 12 by a visit-to a combined, 
      intensive physician-and-nurse-directed HF outpatient clinic, starting within a 
      week after hospital discharge from the hospital or referral from the outpatient 
      clinic. Verbal and written comprehensive education, optimisation of treatment, 
      easy access to the clinic, recommendations for exercise and rest, and advice for 
      symptom monitoring and self-care were provided. Usual care included outpatient 
      visits initialized by individual cardiologists in the cardiology departments 
      involved and applying the guidelines of the European Society of Cardiology. 
      RESULTS: During the 12-month study period, the number of admissions for worsening 
      HF and/or all-cause deaths in the intervention group was lower than in the 
      control group (23 vs 47; relative risk (RR) 0.49; 95% confidence interval (CI) 
      0.30 to 0.81; p = 0.001). There was an improvement in left ventricular ejection 
      fraction (LVEF) in the intervention group (plus 2.6%) compared with the usual 
      care group (minus 3.1%; p = 0.004). Patients in the intervention group were 
      hospitalised for a total of 359 days compared with 644 days for those in the 
      usual care group. Beneficial effects were also observed on NYHA classification, 
      prescription of spironolactone, maximally reached dose of beta-blockers, quality 
      of life, self-care behaviour and healthcare costs. CONCLUSION: A heart failure 
      clinic involving an intensive intervention by both a clinician and a 
      cardiovascular nurse substantially reduces hospitalisations for worsening HF 
      and/or all-cause mortality and improves functional status, while decreasing 
      healthcare costs, even in a country with a primary-care-based healthcare system.
FAU - de la Porte, Pieta W F Bruggink-Andre
AU  - de la Porte PW
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, Utrecht, The Netherlands.
FAU - Lok, Dirk J A
AU  - Lok DJ
FAU - van Veldhuisen, Dirk J
AU  - van Veldhuisen DJ
FAU - van Wijngaarden, Jan
AU  - van Wijngaarden J
FAU - Cornel, Jan H
AU  - Cornel JH
FAU - Zuithoff, Nicolaas P A
AU  - Zuithoff NP
FAU - Badings, Erik
AU  - Badings E
FAU - Hoes, Arno W
AU  - Hoes AW
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20061025
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
MH  - Aged
MH  - Ambulatory Care/*methods
MH  - Female
MH  - Heart Failure/mortality/*therapy
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Netherlands
MH  - Nursing Care/methods
MH  - Quality of Life
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/mortality/therapy
PMC - PMC1994472
COIS- Competing interests: None.
EDAT- 2006/10/27 09:00
MHDA- 2007/07/21 09:00
PMCR- 2010/07/01
CRDT- 2006/10/27 09:00
PHST- 2006/10/27 09:00 [pubmed]
PHST- 2007/07/21 09:00 [medline]
PHST- 2006/10/27 09:00 [entrez]
PHST- 2010/07/01 00:00 [pmc-release]
AID - hrt.2006.095810 [pii]
AID - ht95810 [pii]
AID - 10.1136/hrt.2006.095810 [doi]
PST - ppublish
SO  - Heart. 2007 Jul;93(7):819-25. doi: 10.1136/hrt.2006.095810. Epub 2006 Oct 25.