Evidence-based chronic heart-failure management programs : myth or reality?

Driscoll, A., Worrall-Carter, L., Hare, D.L., Davidson, P.M., Riegel, B., Tonkin, A. and Stewart, S. 2011, Evidence-based chronic heart-failure management programs : myth or reality?, BMJ quality and safety, vol. 20, no. 1, pp. 31-37, doi: 10.1136/bmjqs.2008.028035.

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Title Evidence-based chronic heart-failure management programs : myth or reality?
Author(s) Driscoll, A.ORCID iD for Driscoll, A. orcid.org/0000-0002-6837-0249
Worrall-Carter, L.
Hare, D.L.
Davidson, P.M.
Riegel, B.
Tonkin, A.
Stewart, S.
Journal name BMJ quality and safety
Volume number 20
Issue number 1
Start page 31
End page 37
Total pages 7
Publisher BMJ Group
Place of publication London, England
Publication date 2011-01
ISSN 2044-5415
Summary Background Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). Objective To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. Design A prospective cross-sectional survey was used to conduct a national audit. Setting Community setting of CHF-MPs for patients postdischarge. Sample All CHF-MPs operating during 2005–2006 (n=55). Also 10–50 consecutive patients from 48 programmes were recruited (n=1157). Main outcome measures (1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes. Results Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26–260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), β-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%). Conclusion CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.
Language eng
DOI 10.1136/bmjqs.2008.028035
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2011, BMJ Group
Persistent URL http://hdl.handle.net/10536/DRO/DU:30056046

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