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The Authors Also Make The Point Relative To Drug Compliance, That Most ...



The authors also make the point relative to drug compliance, that most physicians tend to overestimate patient's compliance with drug regimes. (Stewart S et al. 1999{B}). The very fact that a nurse is able to spend more time for both empowerment and education of the patient is also thought to be significant in achieving optimum results.

Another very valid and pertinent point is in the optimum timing of the first post-discharge visit. No other paper appears to have addressed this point either. The authors point out that by delaying the time of the first visit to 7-10 days post discharge by virtue of the fact that this allowed sufficient time for potential problems to become clinically manifest, this also allowed nearly 10% of the patients to either die or be readmitted before they saw the intervention healthcare professionals. This might reflect the fact that the study was only looking at those patients at the severe end of the clinical spectrum and who might therefore be expected to be less stable than the average patient in heart failure .

The Blue paper is comparatively unusual in the context of the published literature as it is presented by the specialist nurse who was active in the study itself. We note that Blue is actually quite a prolific researcher and has written a number of papers in this particular clinical area. This study is another randomised prospective controlled study which followed up patients with a nurse-led intervention over a 12 month period. It had an entry cohort of 165 patients.

Once again the control group had the usual treatment which was not specified other than a follow up by either the admitting cardiologist or GP. The intervention was comparatively low key (as compared to some of the other interventions described) and consisted of a number of planned visits with a decreasing frequency but with the proviso that the patient have a telephone contact if required. The specified purpose of these visits was to:
educate the patient about heart failure and its treatment, optimise treatment (drugs, diet, exercise), monitor electrolyte concentrations, teach self monitoring and management (especially the early detection and treatment of decompensation), liase with other health care and social workers as required, and provide psychological support.

In contrast to many UK based studies, the nurses in this study were allowed to prescribe (on a protocol led basis) drugs such as ACE inhibitors, diuretics and digoxin.

The results of this trial were slightly different to results obtained in many of the other trials reviewed. It may be of significance that more patients in the intervention group had been started on ACE inhibitors and stopped a calcium channel blocker by the end of the study. Hospital admissions were slightly less frequent in the intervention group (31 vs. 43) and also were shorter on average than in the control group.

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