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Heart Failure Patients Fare Better With Follow-Up Nursing Care

TUESDAY, Aug. 15 (HealthDay News) -- Heart failure patients who get follow-up care from nurses have fewer hospitalizations and function better than patients who receive what is considered usual care, researchers from Mount Sinai School of Medicine in New York City report.

Some 5 million Americans live with heart failure, according to the American Heart Association. It's a serious condition that can lead to difficulty breathing and walking, and to an early death. Hpwever, with treatment and self-management, patients can live a full and enjoyable life.

However, patients may not have the skills to manage their condition, and clinical care may fall short of guidelines, the researchers said.

"Having heart failure patients work with nurses to help them learn to manage their condition results in the patients feeling better and being able to carry out everyday activities a lot better," said lead researcher Jane Sisk, a professor of health policy at Mount Sinai School of Medicine and director of the Division of Health Care Statistics at the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

The report was published in the Aug. 15 issue of the Annals of Internal Medicine.

In the study, Sisk's team enrolled heart-failure patients from ambulatory practices in Harlem hospitals. About half of the patients were black; one-third were Hispanic.

Over a year, nurses counseled patients on the benefits of a low-salt diet, the importance of taking medications, and self-management of symptoms. The nurses also arranged medication changes and tests.

After nine months, patients receiving the nursing care had only slight limitations in their physical activities, while usual-care patients reported marked limitations in functioning. Patients in the usual-care group received standard treatment for heart failure, including medications and hospitalization, and doctor visits as needed.

At 12 months, nurse-managed patients had fewer hospitalizations (143 vs. 180) and better functioning than usual-care patients. Over 18 months, the nurse-managed patients had 55 fewer hospitalizations.

Both patients and doctors were receptive to the program, Sisk said. "The results point to the fact that the people assigned to work with a nurse did better," she said. "It would not be difficult to expand this program to other places."

After the program ended, however, the functioning of those seeing nurses worsened at rates similar to those of the usual-care group, Sisk's group found.

Sisk plans to review the data to see if the program was cost-effective.

"As physicians, we want to make sure patients are following every recommendation. A complete, well-rounded treatment approach must have patient involvement," study co-author Dr. Mary Ann McLaughlin, co-director of the Women's Cardiovascular Assessment and Risk Evaluation Program at Mount Sinai, said in a prepared statement. "Self-management of this disease can mean slowing the progression of this disease."

One expert thinks that this type of care can help heart failure patients improve their condition.

"This paper underscores the fact that managing one's heart failure is extremely complicated," said Dr. Byron K. Lee, an assistant professor of cardiology at the University of California, San Francisco.

"Patients are often on more than six medicines," Lee added. "They have to watch their weight and diet religiously to avoid decompensation. Therefore, it is not surprising that extra monitoring and attention from a bilingual nurse would help patients, especially non-English speaking ones, stay out of the hospital."

More information

The American Heart Association can tell you more about heart failure.