When The Doctor Is Out, Nurses Next Line of Defense For Heart Patients
Heart Patients and Nurse
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 Heart 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."