PMID- 18403998
OWN - NLM
STAT- MEDLINE
DCOM- 20080826
LR  - 20090528
IS  - 1558-2027 (Print)
IS  - 1558-2027 (Linking)
VI  - 9
IP  - 5
DP  - 2008 May
TI  - Survival and hospitalization in a nurse-led domiciliary intervention for elderly 
      heart failure patients.
PG  - 470-5
LID - 10.2459/JCM.0b013e3282f19350 [doi]
AB  - AIM: Heart failure in the elderly population represents a complex clinical 
      situation associated with frequent hospitalizations and numerous comorbidities. 
      The present study aimed to evaluate the impact of a domiciliary-based nurse-led 
      strategy in a group of very elderly patients affected by heart failure who were 
      regularly seen at an outpatient heart failure clinic (HFC). METHODS: Patients 
      were periodically assessed in their homes by two trained nurses under supervision 
      of the cardiologists of the HFC. During each visit, the nurses examined clinical 
      status and adherence to medication. When necessary, they also gathered venous 
      blood samples for laboratory analysis and recorded an electrocardiogram. In 
      addition, they provided key information regarding disease management to patients 
      as well as to their care givers. During the baseline visit and, subsequently, 
      every 6 months, an echocardiogram was performed at the HFC. RESULTS: Forty-four 
      patients (52.4% male, median age 82 years) were followed up for a mean of 25 +/- 
      12 months. Compared to an equally long time period before randomization, during 
      follow-up, a significant reduction in cardiac hospitalizations (from 1.83 +/- 
      1.54 to 1.07 +/- 1.39, P = 0.004), total hospitalizations (from 2.09 +/- 1.71 to 
      1.52 +/- 1.68, P = 0.003), HFC visits (from 3.31 +/- 2.33 to 2.24 +/- 1.38, P = 
      0.03) and New York Heart Association (NYHA) class (from 2.74 +/- 0.70 to 2.49 +/- 
      0.61, P = 0.04) was observed. Total 1-year mortality was 25% and was predicted by 
      several clinical (weight loss, NYHA class), laboratory (hyperuricaemia, anaemia, 
      renal failure, hyposodiemia) and echocardiographic (end-systolic diameter, 
      ejection fraction, systolic pulmonary artery pressure) parameters. Multivariate 
      analysis revealed that hyperuricaemia was as an independent predictor of 
      mortality (odds ratio = 1.53, P = 0.038). CONCLUSIONS: The present study 
      demonstrates that a domiciliary-based strategy in elderly patients affected by 
      heart failure guarantees clinical stability and reduces hospitalizations as well 
      as outpatient visits.
FAU - Rondinini, Lorenzo
AU  - Rondinini L
AD  - Universita degli Studi, Ospedale Cisanello, Pisa, Italy.
FAU - Coceani, Michele
AU  - Coceani M
FAU - Borelli, Gabriele
AU  - Borelli G
FAU - Guideri, Silvia
AU  - Guideri S
FAU - Chini, Cristina
AU  - Chini C
FAU - Frediani, Maria Rosa
AU  - Frediani MR
FAU - Maccari, Mauro
AU  - Maccari M
FAU - Mariotti, Rita
AU  - Mariotti R
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - J Cardiovasc Med (Hagerstown)
JT  - Journal of cardiovascular medicine (Hagerstown, Md.)
JID - 101259752
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/mortality/*nursing
MH  - *Home Care Services
MH  - *Hospitalization
MH  - Humans
MH  - Male
MH  - Outpatient Clinics, Hospital
MH  - Survival Rate
EDAT- 2008/04/12 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/04/12 09:00
PHST- 2008/04/12 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/04/12 09:00 [entrez]
AID - 01244665-200805000-00004 [pii]
AID - 10.2459/JCM.0b013e3282f19350 [doi]
PST - ppublish
SO  - J Cardiovasc Med (Hagerstown). 2008 May;9(5):470-5. doi: 
      10.2459/JCM.0b013e3282f19350.