An overview of the management of Congestive Heart Failure in Malta

Background: In July 2003 the National Institute of Clinical Excellence (NICE) issued guidelines on the management of congestive heart failure. We set out to assess the management of congestive heart failure in St. Luke's Hospital (SLH), Malta. Methods: The files of patients admitted to SLH during the month of January 2002 were retrieved. Eligible patients were those with a history of congestive heart failure. Patients who had passed away by the time of the audit or whose files were untraceable were excluded from the audit. Data from the file pertaining to that specific admission was entered in a preprepared data sheet. This includes demographic data about the patient, investigations performed to reach diagnosis and assess severity, pharmacological and non-pharmacological management of heart failure, and planned follow-up at time of discharge. Results: The management of 97 patients was assessed. All patients with a clinical diagnosis of congestive heart failure had an electrocardiogram, chest X-ray, urea, electrolytes and creatinine estimation and a full blood count. Regarding the other tests recommended by NICE, echocardiography was performed in 28% of patients, serum glucose was assayed in 87%, liver function tests in 36%, thyroid function tests in 24%, urinalysis in 13%, lipids in 8% and spirometry in none. Two per cent of patients had lifestyle modification advice documented in the file. Pharmacological treatment consisted of diuretics (98%), ACE inhibitors (71%), angiotensin II receptor blockers (4%), ß-blockers (9%), spironolactone (12%) and digoxin (25%). Conclusions: There is still scope for improvement in the management of congestive heart failure locally.peer-reviewe

Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages