PMID- 25248944
OWN - NLM
STAT- MEDLINE
DCOM- 20150602
LR  - 20240512
IS  - 1756-0500 (Electronic)
IS  - 1756-0500 (Linking)
VI  - 7
DP  - 2014 Sep 23
TI  - A nurse-led up-titration clinic improves chronic heart failure optimization of 
      beta-adrenergic receptor blocking therapy--a randomized controlled trial.
PG  - 668
LID - 10.1186/1756-0500-7-668 [doi]
LID - 668
AB  - BACKGROUND: Beta-adrenergic blockade has been shown to improve left ventricular 
      function, reduce hospital admissions and improve survival in chronic heart 
      failure with reduced ejection fraction (HFrEF), with mortality reduction starting 
      early after beta-adrenergic receptor blocker initiation and being dose-related. 
      The aim of this pilot study was to determine the effectiveness of a nurse-led 
      titration clinic in improving the time required for patients to reach optimal 
      doses of the beta-adrenergic receptor blocking agents. METHOD: We conducted a 
      prospective pilot randomized controlled trial. Twenty eight patients with CHF 
      were randomized to optimisation of beta-adrenergic receptor blocker therapy over 
      six months by either a nurse-led titration (NLT) clinic, led by a nurse 
      specialist with the support of a cardiologist in a CHF clinic, or by their 
      primary care physician (usual care (UC)). The primary endpoint was time to 
      maximal beta-adrenergic receptor blocker dose. The secondary end-point was the 
      proportion of patients reaching the target dose of beta-adrenergic receptor 
      blocker by six months. RESULTS: The patients were predominantly men (72%), age 67 
      +/- 16 years; New York Heart Association (NYHA) functional class I (32%), II (44%) 
      and III (20%); baseline left ventricular ejection fraction 33 +/- 10%, and a low 
      mean Charlson co-morbidity score of 2.5 +/- 1.4. The time to maximum dose was 
      shorter in the NLT group compared to the UC group (90 +/- 14 vs 166 +/- 8 days, p < 
      0.0005). At six months, in the NLT group there were nine patients (82%) on high 
      dose and one patient (9%) on low dose beta-adrenergic receptor blocker compared 
      to the UC group with five (42%) patients reaching maximum dose and five (42%) 
      patients on low dose (p = 0.04). The patients allocated to the NLT group also had 
      significantly less worsening of depression between baseline and six months (p = 
      0.006). CONCLUSION: A NLT clinic improves optimisation of beta-adrenergic 
      receptor blocker therapy through increasing the proportion of patients reaching 
      maximal dose and facilitating rapid up-titration of beta-adrenergic receptor 
      blocker agents in patients with chronic HFrEF. TRIAL REGISTRATION: Australian 
      Clinical Trials Registry (ACTRN012606000383561).
FAU - Driscoll, Andrea
AU  - Driscoll A
AD  - School of Nursing and Midwifery, Deakin University, 225 Burwood Highway, 
      Melbourne, Burwood, Australia. andrea.driscoll@deakin.edu.au.
FAU - Srivastava, Piyush
AU  - Srivastava P
FAU - Toia, Deidre
AU  - Toia D
FAU - Gibcus, Jackie
AU  - Gibcus J
FAU - Hare, David L
AU  - Hare DL
LA  - eng
SI  - ANZCTR/ACTRN012606000383561
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20140923
PL  - England
TA  - BMC Res Notes
JT  - BMC research notes
JID - 101462768
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Aged
MH  - Chronic Disease
MH  - Female
MH  - Heart Failure/*drug therapy/nursing
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Practice Patterns, Nurses'
MH  - Prospective Studies
PMC - PMC4182807
EDAT- 2014/09/25 06:00
MHDA- 2015/06/03 06:00
PMCR- 2014/09/23
CRDT- 2014/09/25 06:00
PHST- 2014/02/13 00:00 [received]
PHST- 2014/09/06 00:00 [accepted]
PHST- 2014/09/25 06:00 [entrez]
PHST- 2014/09/25 06:00 [pubmed]
PHST- 2015/06/03 06:00 [medline]
PHST- 2014/09/23 00:00 [pmc-release]
AID - 1756-0500-7-668 [pii]
AID - 3199 [pii]
AID - 10.1186/1756-0500-7-668 [doi]
PST - epublish
SO  - BMC Res Notes. 2014 Sep 23;7:668. doi: 10.1186/1756-0500-7-668.