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Nurse-Led Heart Failure Clinics Are Associated With Reduced Mortality but Not Heart Failure Hospitalization
Karolinska Inst, Sweden.
Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-6353-8041
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0002-4259-3671
2019 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, no 10, article id e011737Article in journal (Refereed) Published
Abstract [en]

Background-Follow-up in a nurse-led heart failure (HF) clinic is recommended in HF guidelines, but its association with outcomes remains controversial, with previous studies including few and highly selected patients. Thus, large analyses of "real-world" samples are needed. Aims were to assess: (1) independent predictors of and (2) prognosis associated with planned referral to nurse-led HF clinics. Methods and Results-We analyzed data from the SwedeHF (Swedish HF Registry) using multivariable logistic regressions to identify independent predictors of planned referral to a nurse-led HF clinic and multivariable Cox regressions to test associations between planned referral and outcomes (all-cause death, HF hospitalization, and their composite). Of 40 992 patients, 39% were planned to be referred to a follow-up in a nurse-led HF clinic. Independent characteristics associated with planned referral were shorter duration of HF, clinical markers of more-severe HF, such as lower ejection fraction, higher New York Heart Association class and N-terminal pro-B-type natriuretic peptide, and lower blood pressure, as well as cohabitating versus living alone, male sex, fewer comorbidities, and more use of HF treatments. After adjustments, planned referral to a nurse-led HF clinic was associated with reduced mortality and mortality/HF hospitalization, but not HF hospitalization alone. Conclusions-In this nation-wide registry, 39% of our identified HF cohort was planned to be referred to a nurse-led HF clinic. Planned referral reflected more-severe HF, but also sex- and family-related factors, and it was independently associated with lower risk of death, but not of HF hospitalization.

Place, publisher, year, edition, pages
WILEY , 2019. Vol. 8, no 10, article id e011737
Keywords [en]
follow-up; heart failure; hospitalization; nurse-led clinic; registry; survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-160631DOI: 10.1161/JAHA.118.011737ISI: 000484575000010PubMedID: 31094284OAI: oai:DiVA.org:liu-160631DiVA, id: diva2:1360194
Note

Funding Agencies|Swedish Research CouncilSwedish Research Council [2013-23897-104604-23, 5232014-2336]; Swedish Heart Lung FoundationSwedish Heart-Lung Foundation [20120321, 20150557]

Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-12-03

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