When the doctor is out, nurses next line of defense for heart patients
Landmark study finds nurses key to improving functioning in heart failure patients in African-American and Hispanic communities
(New York, New York -- August 9, 2006) -- According to a landmark study by researchers at Mount Sinai School of Medicine, heart failure (HF) patients who received routine follow-up by a nurse in addition to visits to a physician had fewer hospitalizations and functioned better than patients who received only usual care. The study appears in the August 15, 2006 issue of the Annals of Internal Medicine.
According to the American Heart Association, nearly five million Americans are living with heart failure - - a serious condition that can lead to difficulty breathing and walking, and to an early death. With appropriate treatment and self-management, patients with HF can live a full and enjoyable life. But patients may not have the skills to manage their condition, and clinical care may fall short of guidelines.
"Heart failure is very serious, but patients can play a critical role in managing the condition and improving the quality of their lives," said Jane Sisk, Ph.D., Professor of Health Policy at Mount Sinai School of Medicine, Director of the Division of Health Care Statistics at the CDC's National Center for Health Statistics, and lead author of this study. "This study has shown that with routine counseling and encouragement from a nurse, patients can perform everyday activities better and have fewer hospitalizations. These results could help to improve care for patients in other minority communities."
About the Study
Mount Sinai School of Medicine investigators compared the effects of a nurse-led intervention focused on specific management problems versus usual care among ethnically-diverse patients in ambulatory practices. The patients, whose hearts were too weak to pump blood strongly enough throughout the body, were enrolled from ambulatory practices in Harlem hospitals. About half of the patients were African American and one-third were Hispanic. During the 12-month intervention period, bi-lingual nurses counseled patients on the benefits of a low-salt diet, importance of taking prescribed medications, and self-management of symptoms through an initial visit and regularly-scheduled follow-up telephone calls. The nurses also arranged any medication changes and tests with the patients' clinicians, who remained in charge of patients' care. Although both groups started out at the same level of functioning, by 9 months, nurse-managed patients experienced only slight limitations in their physical activities, while usual-care patients reported marked limitations in functioning. That difference was statistically significant and maintained throughout the 12-month intervention period.
At 12 months, nurse-management patients had fewer hospitalizations (143 vs. 180) and better functioning than usual care patients. Cumulatively over 18 months, the nurse group had 55 fewer hospitalizations.
Emergency department visits, patients hospitalized at least once, and prescribed medications did not differ between the two groups. After the intervention ended, nurse patients' functioning worsened and declined at rates similar to those of the usual-care group.
"As physicians, we want to make sure patients are following every recommendation. A complete, well-rounded treatment approach must have patient involvement," said Mary Ann McLaughlin, MD, Assistant Professor of Health Policy at Mount Sinai School of Medicine, Co-Director of the Women's Cardiovascular Assessment and Risk Evaluation Program at Mount Sinai Heart, and co-investigator of the study. "Self-management of this disease can mean slowing the progression of this disease."
Nurse management of heart failure patients in ambulatory practices in African-American and Hispanic communities improved their everyday functioning and reduced hospitalizations. Continuing contact with the nurse may be necessary to sustain these benefits
This study was funded by the U.S. Agency for Healthcare Research and Quality (AHRQ).
About Mount Sinai School of Medicine
Located in Manhattan, Mount Sinai School of Medicine is internationally recognized for ground-breaking clinical and basic-science research, and innovative approaches to medical education. Through the Mount Sinai Graduate School of Biological Sciences, Mount Sinai trains biomedical researchers with an emphasis on the rapid translation of discoveries of basic research into new techniques for fighting disease. One indication of Mount Sinai's leadership in scientific investigation is its receipt during fiscal year 2005 of $174.1 million in research support from the NIH. Mount Sinai School of Medicine also is known for unique educational programs such as the Humanities in Medicine program, which creates opportunities for liberal arts students to pursue medical school, and instructional innovations like The Morchand Center, the nation's largest program teaching students and physicians with "standardized patients" to become not only highly skilled, but compassionate caregivers. Long dedicated to improving its community, the School extends its boundaries to work with East Harlem and surrounding communities to provide access to health care and educational programs to at risk populations.
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