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Feasibility of evidence-based diagnosis and management of heart failure in older people in care : a pilot randomised controlled trial.

By H.C. Hancock, H. Close, J.M. Mason, J.J. Murphy, A. Fuat, M. de Belder, T. Hunt, A. Baker, D. Wilson and A.P.S. Hungin

Abstract

Background: Many older people in long-term care do not receive evidence-based diagnosis or management for\ud heart failure; it is not known whether this can be achieved for this population. We initiated an onsite heart failure\ud service, compared with ‘usual care’ with the aim of establishing the feasibility of accurate diagnosis and appropriate\ud management.\ud Methods: A pilot randomised controlled trial which randomised residents from 33 care facilities in North-East\ud England with left ventricular systolic dysfunction (LVSD) to usual care or an onsite heart failure service. The primary\ud outcome was the optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic\ud antagonists at 6 months.\ud Results: Of 399 echocardiographically-screened residents aged 65–100 years, 30 subjects with LVSD were eligible;\ud 28 (93%) consented and were randomised (HF service: 16; routine care: 12). Groups were similar at baseline; six\ud month follow-up was completed for 25 patients (89%); 3 (11%) patients died. Results for the primary outcome were\ud not statistically significant but there was a consistent pattern of increased drug use and titration to optimum dose\ud in the intervention group (21% compared to 0% receiving routine care, p=0.250). Hospitalisation rates, quality of life\ud and mortality at 6 months were similar between groups.\ud Conclusions: This study demonstrated the feasibility of an on-site heart failure service for older long-term care\ud populations. Optimisation of medication appeared possible without adversely affecting quality of life; this questions\ud clinicians’ concerns about adverse effects in this group. This has international implications for managing such\ud patients. These methods should be replicated in a large-scale study to quantify the scale of benefit.\ud Trial registration: ISRCTN19781227 http://www.controlled-trials.com/ISRCTN1978122

Topics: Chronic heart failure, Treatment outcomes, Randomised controlled trial, Older people, Long-term care.
Publisher: BioMed Central
Year: 2012
DOI identifier: 10.1186/1471-2318-12-70
OAI identifier: oai:dro.dur.ac.uk.OAI2:10745
Journal:

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