Introduction of a heart failure nurse for the support of in-hospital management of mainly elderly patients with acute HF results in a better outcome after 1 year follow-up

Purpose: The optimal in-hospital and pre-discharge management of the mainly elderly patients hospitalised for acute Heart Failure (HF) is still a matter of debate. We evaluated the short and long-term effects of the introduction of a HF nurse for the support of the in-hospital management of these patients. The specific tasks of the HF nurse included participation in daily ward rounds, patient counseling and a pre-discharge medication check. Methods: We performed a sequential comparison of all consecutive patients admitted with HF at the department of cardiology during 2 study periods: group 1 (2008-2009) before introduction of the HF nurse (n=388 pts, mean age 78±11 years, 44% women, 43% HFPEF) and group 2 (2010-2011) after introduction of the HF nurse (n=450 pts, mean age 78±11 years, 46% women, 40% HFPEF). Baseline clinical characteristics, hospitalisation duration and in-hospital mortality as well as pre-discharge medication were compared between the 2 groups. All patients were followed for 1 year for the combined end-point of all-cause mortality and rehospitalisation for HF. Results: Baseline characteristics including clinical characteristics, severity of HF and comorbidities were comparable between the two groups. Although in-hospital mortality was comparable (6.7% vs 8.7%, p=0.30) hospitalisation duration was shorter for group 2 (8 days for group 1 (IQ range 6-14) vs 7 days for group 2 (IQ range 5-13), p=0.034). Introduction of the HF nurse resulted also in a significantly higher use of beta-blockers and mineralocorticoid receptor antagonists at discharge (both for all patients as for the HFREF patients in group 2). After 1 year FU, 156 pts (44%) had died or were rehospitalised for HF in group 1 and 88 patients in group 2 (23%, p<0.01). In multivariate Cox regression analysis, introduction of a HF nurse was associated with a 33% (95% CI 11%-50%, p<0.01) reduction of all cause-mortality or rehospitalisation for HF. Conclusion: The introduction of a HF nurse for the support of the in-hospital management of mainly elderly patients admitted with acute HF, was associated with a shorter in-hospital stay, a more frequent use of evidence-based medication at discharge and a significant reduction of the combined endpoint of all-cause mortality and rehospitalisation for HF after 1 year follow-up.