Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial.
Monica Isabelle Lopes Oscalices, Meiry Fernanda Pinto Okuno, Maria Carolina Barbosa Teixeira Lopes and 2 others
PMID 31432915WHAT IT FOUND
Nurse-delivered individualized discharge guidance and telephone follow-up increased heart failure patients' drug and non-drug adherence at 90 days and lowered re-hospitalization compared with a standard brochure and assessment call.
The two parts cannot be separated.
Key findings
01Ninety days after discharge, intervention patients were 3.8 times more likely to adhere to drug treatment than control patients.
02At 90 days, 26% of intervention patients and 38.6% of control patients were rehospitalized, and the intervention group had a lower rehospitalization rate.
03The intervention combined individualized discharge guidance and telephone follow-up, so the effectiveness of each component cannot be separated.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Follow-up was only to 90 days, which the authors say may not capture longer-term heart failure outcomes. The intervention combined individualized discharge guidance and telephone follow-up, so neither component can be credited alone. It was a single-centre emergency cardiology study in Brazil, and the participants were already admitted with decompensated heart failure. The trial was not blinded, and all interventions were delivered by one researcher. The control group also received a telephone assessment call at three months, so the comparison is not telephone follow-up versus no telephone contact. At 90 days, 98 of 100 intervention patients and 95 of 101 control patients were analysed, with losses due to death.
The easy way to misread this
Do not conclude that telephone follow-up alone improved adherence. The intervention group received individualized discharge guidance and telephone follow-up together, and the paper states their association does not allow evaluating each strategy separately.