Effects of a nurse-based heart failure clinic on drug utilization and admissions in a community hospital setting

OBJECTIVE: To evaluate the effect of a nurse-led heart failure clinic on drug therapy and hospitalization in a community hospital setting.

DESIGN: Prospective, observational study of outpatients referred to a heart failure clinic. Nurses directed drug uptitration and delivered patient education. Utilization and doses of ACE inhibitors and beta-blockers were analyzed as were heart failure related admissions in the years before and after establishing the clinic.

RESULTS: 138 patients (median age 68.5 years) were enrolled. After three months 94% of patients were taking an ACE inhibitor and beta-blockade was prescribed for 91%. Mean ACE inhibitor dose relative to target dose after three months was 77+/-30% and mean beta-blocker dose was 53+/-31% of the target dose. Heart failure admissions decreased by 45% after the clinic was established.

CONCLUSIONS: Community hospital based heart failure clinics may promote utilization of evidence based drug therapy and cause a substantial decrease in heart failure admissions, producing results comparable to those obtained in studies of university hospital based heart failure management programs.