A Randomized Controlled Trial of Heart Failure Disease Management in Skilled Nursing Facilities.
Rebecca S Boxer, Mary A Dolansky, Erin L Chaussee and 5 others
PMID 34146521WHAT IT FOUND
Nurse-led heart failure management in skilled nursing facilities did not significantly reduce the main combined outcome of rehospitalization, emergency visits, or mortality.
Rehospitalization and mortality were lower in the intervention group.
Key findings
01The nurse-led heart failure disease management program did not significantly reduce the primary composite outcome at 30 or 60 days.
02After the primary outcome, the 60-day rehospitalization and mortality rates were higher in usual care than in the intervention group.
03Physical and social limitation scores improved with the intervention, while heart failure self-care scores did not change significantly.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The trial may have been underpowered for the primary outcome. The primary outcome timing was changed during the study. Many patients did not complete the follow-up phone call, and the quality-of-life results depended on assumptions about missing scores. The intervention was delivered by a research nurse outside the facility staff, which may limit routine use. Clinicians could choose whether to follow recommendations, and medication changes were often not made. Weight monitoring was inconsistent.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that nurse-led heart failure management alone caused the lower rehospitalization and mortality rates. The program included assessment, weight checks, diet advice, medication recommendations, education, and follow-up, and the study cannot separate their effects.