When the doctor is out, nurses next line of defense for heart patients

August 14, 2006

(New York, New York -- August 9, 2006) -- According to a landmark study by researchers at Mount Sinai School of Medicine, heart failure (HF) patients who received routine follow-up by a nurse in addition to visits to a physician had fewer hospitalizations and functioned better than patients who received only usual care. The study appears in the August 15, 2006 issue of the Annals of Internal Medicine.

According to the American Heart Association, nearly five million Americans are living with heart failure - - a serious condition that can lead to difficulty breathing and walking, and to an early death. With appropriate treatment and self-management, patients with HF can live a full and enjoyable life. But patients may not have the skills to manage their condition, and clinical care may fall short of guidelines.

"Heart failure is very serious, but patients can play a critical role in managing the condition and improving the quality of their lives," said Jane Sisk, Ph.D., Professor of Health Policy at Mount Sinai School of Medicine, Director of the Division of Health Care Statistics at the CDC's National Center for Health Statistics, and lead author of this study. "This study has shown that with routine counseling and encouragement from a nurse, patients can perform everyday activities better and have fewer hospitalizations. These results could help to improve care for patients in other minority communities."

About the Study

Mount Sinai School of Medicine investigators compared the effects of a nurse-led intervention focused on specific management problems versus usual care among ethnically-diverse patients in ambulatory practices. The patients, whose hearts were too weak to pump blood strongly enough throughout the body, were enrolled from ambulatory practices in Harlem hospitals. About half of the patients were African American and one-third were Hispanic. During the 12-month intervention period, bi-lingual nurses counseled patients on the benefits of a low-salt diet, importance of taking prescribed medications, and self-management of symptoms through an initial visit and regularly-scheduled follow-up telephone calls. The nurses also arranged any medication changes and tests with the patients' clinicians, who remained in charge of patients' care. Although both groups started out at the same level of functioning, by 9 months, nurse-managed patients experienced only slight limitations in their physical activities, while usual-care patients reported marked limitations in functioning. That difference was statistically significant and maintained throughout the 12-month intervention period.

At 12 months, nurse-management patients had fewer hospitalizations (143 vs. 180) and better functioning than usual care patients. Cumulatively over 18 months, the nurse group had 55 fewer hospitalizations.

Emergency department visits, patients hospitalized at least once, and prescribed medications did not differ between the two groups. After the intervention ended, nurse patients' functioning worsened and declined at rates similar to those of the usual-care group.

"As physicians, we want to make sure patients are following every recommendation. A complete, well-rounded treatment approach must have patient involvement," said Mary Ann McLaughlin, MD, Assistant Professor of Health Policy at Mount Sinai School of Medicine, Co-Director of the Women's Cardiovascular Assessment and Risk Evaluation Program at Mount Sinai Heart, and co-investigator of the study. "Self-management of this disease can mean slowing the progression of this disease."

The Conclusions

Nurse management of heart failure patients in ambulatory practices in African-American and Hispanic communities improved their everyday functioning and reduced hospitalizations. Continuing contact with the nurse may be necessary to sustain these benefits
-end-
This study was funded by the U.S. Agency for Healthcare Research and Quality (AHRQ).

About Mount Sinai School of Medicine
Located in Manhattan, Mount Sinai School of Medicine is internationally recognized for ground-breaking clinical and basic-science research, and innovative approaches to medical education. Through the Mount Sinai Graduate School of Biological Sciences, Mount Sinai trains biomedical researchers with an emphasis on the rapid translation of discoveries of basic research into new techniques for fighting disease. One indication of Mount Sinai's leadership in scientific investigation is its receipt during fiscal year 2005 of $174.1 million in research support from the NIH. Mount Sinai School of Medicine also is known for unique educational programs such as the Humanities in Medicine program, which creates opportunities for liberal arts students to pursue medical school, and instructional innovations like The Morchand Center, the nation's largest program teaching students and physicians with "standardized patients" to become not only highly skilled, but compassionate caregivers. Long dedicated to improving its community, the School extends its boundaries to work with East Harlem and surrounding communities to provide access to health care and educational programs to at risk populations.

The Mount Sinai Hospital / Mount Sinai School of Medicine

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.