Nurse-Led Care Effective for Heart Failure Patients in Minority Communities

Newswise — Patients with heart failure whose care was directed by nurse managers could perform everyday activities better and had fewer hospitalizations than patients who self-managed their own care, according to a study funded by HHS' Agency for Healthcare Research and Quality that appears in the August 15 Annals of Internal Medicine. Heart failure is a condition in which the heart becomes too weak to adequately deliver oxygen-rich blood throughout the body. Over time this condition can cause a buildup of fluid or congestion in the lungs and other body tissues.

Researchers led by Jane Sisk, Ph.D., of Mount Sinai School of Medicine and currently at the Centers for Disease Control and Prevention's National Center for Health Statistics, enrolled 406 heart failure patients, about one-half who were African American and one-third who were Hispanic, from ambulatory practices affiliated with Harlem, New York, hospitals. The patients were randomly assigned to a nurse-management group or a usual-care group. By 9 months, nurse-managed patients reported only slight limitations in their physical functioning, while self-managed patients reported marked limitations. This difference persisted through the 12-month intervention period. Also, the nurse-managed patients had fewer hospitalizations at 12 months, 143 vs. 180 for the usual-care patients.

"Although this randomized study was conducted on a modest-sized and specific population, we can glean lessons that may be extrapolated to an even wider community," said AHRQ Director Carolyn M. Clancy, M.D. "It shows that sustained care that incorporates culturally sensitive nurse management of diet, medication, and other factors is an effective program for minority patients suffering from heart failure."

The nurses counseled patients on the signs and symptoms of heart failure, benefits of a low-salt diet, and the importance of taking prescribed medications. Also, the nurses arranged any medication changes and tests with the patients' clinicians, who remained in charge of patients' care. Patients in the usual care group received only federal consumer guidelines for managing their condition but no other intervention.

The percentage of patients hospitalized at least once, number of emergency department visits, and medications prescribed did not differ between the groups. After 12 months, when the nurses were no longer counseling the patients, researchers found that the nurse-led patients' functioning began decreasing at a rate similar to that of patients who had received no counseling at all.

"This nurse-led program made a significant difference in the everyday lives of heart failure patients. With the nurses' guidance, patients were better able to perform routine activities and were hospitalized less," said Dr. Sisk. "These results could help providers improve care for patients in other minority communities."

Mount Sinai Medical Center and North General Hospital, a nearby community hospital, are continuing this nurse-management treatment through the Alliance for Health Improvement, an organization created in part to develop health improvement programs in Harlem. Under an arrangement with the state of New York that increased the state's Medicaid payments for clinical care, these hospitals agreed to undertake activities to improve the quality of care. The Alliance's heart failure nurse-management program enrolled its first patient in September 2005. Building on the results of this study, nurses in the new program will work with patients beyond 12 months. This heart failure program is the first quality improvement activity for the Alliance for Health Improvement.