Nurse-Led Heart Failure Clinics Are Associated With Reduced Mortality but Not Heart Failure Hospitalization

J Am Heart Assoc. 2019 May 21;8(10):e011737. doi: 10.1161/JAHA.118.011737.

Abstract

Background Follow-up in a nurse-led heart failure ( HF ) clinic is recommended in HF guidelines, but its association with outcomes remains controversial, with previous studies including few and highly selected patients. Thus, large analyses of "real-world" samples are needed. Aims were to assess: (1) independent predictors of and (2) prognosis associated with planned referral to nurse-led HF clinics. Methods and Results We analyzed data from the SwedeHF (Swedish HF Registry) using multivariable logistic regressions to identify independent predictors of planned referral to a nurse-led HF clinic and multivariable Cox regressions to test associations between planned referral and outcomes (all-cause death, HF hospitalization, and their composite). Of 40 992 patients, 39% were planned to be referred to a follow-up in a nurse-led HF clinic. Independent characteristics associated with planned referral were shorter duration of HF , clinical markers of more-severe HF, such as lower ejection fraction, higher New York Heart Association class and N-terminal pro-B-type natriuretic peptide, and lower blood pressure, as well as cohabitating versus living alone, male sex, fewer comorbidities, and more use of HF treatments. After adjustments, planned referral to a nurse-led HF clinic was associated with reduced mortality and mortality/ HF hospitalization, but not HF hospitalization alone. Conclusions In this nation-wide registry, 39% of our identified HF cohort was planned to be referred to a nurse-led HF clinic. Planned referral reflected more-severe HF , but also sex- and family-related factors, and it was independently associated with lower risk of death, but not of HF hospitalization.

Keywords: follow‐up; heart failure; hospitalization; nurse‐led clinic; registry; survival.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Disease Progression
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / mortality
  • Heart Failure / nursing*
  • Heart Failure / physiopathology
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Outpatient Clinics, Hospital*
  • Practice Patterns, Nurses'*
  • Referral and Consultation
  • Registries
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Sweden / epidemiology
  • Time Factors
  • Treatment Outcome