Randomised controlled trial of specialist nurse intervention in heart failure

<p>Objectives. To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure.</p> <p>Design. Randomised controlled trial.</p> <p>Setting. Acute medical admissions unit in a teaching hospital.</p> <p>Participants. 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year.</p> <p>Main outcome measures. Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure.</p> <p>Results. 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96).Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051).</p> <p>Conclusions. Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.</p&gt

Left-ventricular dysfunction

No abstract available

Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population

<p>Background In most previous epidemiological studies on the prevalence of chronic heart failure (CHF) the disorder has been defined on clinical criteria. In a cross-sectional survey of 2000 men and women aged 25–74, randomly sampled from one geographical area, we assessed left- ventricular systolic function by echocardiography.</p> <p>Methods 1640 (83%) of those invited took part. They completed a questionnaire on current medication, history, and symptoms of breathlessness. Blood pressure was measured and electrocardiography (ECG) and echocardiography were done. Left-ventricular ejection fraction was measurable in 1467 (89·5%) participants by the biplane Simpson's rate method.</p> <p>Findings The mean left-ventricular ejection fraction was 47·3%. The prevalence of definite left-ventricular systolic dysfunction (defined as a left-ventricular ejection fraction ≤30%) was 2·9% overall (43 participants); it increased with age and was higher in men than in women (4·0 vs 2·0%). The left-ventricular systolic dysfunction was symptomatic in 1·5% of participants and asymptomatic in 1·4%. 83% of participants with left-ventricular systolic dysfunction had evidence of ischaemic heart disease (IHD) from history or ECG criteria compared with 21% of those without this abnormality (p>0·001). Hypertension was also more common in those with left-ventricular systolic dysfunction (72 vs 38%, p>0·001), but there was no difference between those with and without left-ventricular systolic dysfunction in the rate of hypertension without IHD.</p> <p>Interpretation Left-ventricular systolic dysfunction was at least twice as common as symptomatic heart failure defined by clinical criteria. The main risk factors are IHD and hypertension in the presence of IHD; screening of such high-risk groups for left-ventricular systolic dysfunction should be considered.</p&gt