Table 7.

Congestive Heart Failure

Reference	Design	Intervention	n, Follow-Up, Racial/Ethnic Composition	Setting	Results: Process and Patient Outcomes	Conclusion	Target	Quality Score
Artinian 2003	RCT	Intervention group received usual care plus a Med-e Monitor device with electronic medication reminders; included daily reminders/assessment of medications and symptoms, while monitoring daily weight and BP	n = 18, 3 months, 65% AA class II-III CHF	CHF clinic of a Veterans Affairs Medical Center	Trend toward improved monitoring of daily weight (85% vs. 70%) and BP (81% vs. 51%) in intervention group as compared to control group; QOL improved in intervention group at 3 months (p = .006)	E-monitoring improved QOL, with trend toward improved self-monitoring	Provider & care delivery	22
Benatar 2003	RCT	APN monitored recently discharged patients using transtelephonic home measuring (TTM) device to follow weight, BP, oxygenation, and heart rate or use of home nurse visits	n = 216, 12 months, 86% AA	Home	At 3 months, TTM group had fewer admissions at 13 vs. 24 for home visit group (p ≤ 0.001) and shorter lengths of stay at 49 vs. 105 days (p ≤ 0.001)	Cardiologist-guided computerized monitoring of patients with CHF reduces admission rates and length of stay	Provider & care delivery	22
DeWalt 2004	Pre/post study	Patient education combined with frequent phone follow-up; patients given electronic scale to use for daily weights	n = 25, 3 months, 60% AA with low literacy	University internal medicine clinic	Proportion of patients reporting daily weights from 32% at baseline to 100% at 12 weeks; mean improvement on the MLwHF scale was 9.9 points over the 3-month trial (95% CI: 0.5 to 19.2); mean knowledge scores did not improve	E-monitoring improved QOL, with trend toward improved self-monitoring	Provider & care delivery	16
Naylor 2004	RCT	A 3-month APN-directed discharge planning and home follow-up protocol	n = 239, 1 year, 36% AA (data reported for subgroup of AA patients; personal communication)	Hospital and home follow-up	Intervention patients had lower total number of CHF-related admissions (7 vs. 9) (p < .04) and lower CHF-related admission costs	Cardiologist-guided computerized monitoring of patients with CHF reduces admission rates and length of stay	Provider & care delivery	24
O’Connell 2001	Pre/post study	Multidisciplinary case management program to reduce hospitalizations in indigent HF patients	n = 35, 1 year, 51% Hispanic	Academic teaching hospital-based clinic	Group A (2 hospital readmissions/year): 91% reduction in admissions (p < .001); Group B (difficult to manage): 100% reduction in admissions (p = .002)	Multidisciplinary case management was effective in reducing readmissions in patients with HF	Patient/family	16
Rich 1995, 1996	RCT	Nurse-directed education program for patient and family, prescribed diet, social service consult, medication review, and intensive follow-up	n = 282, 90 days, 55% AA	Home	Intervention reduced HF admissions by 56.2% (p = .04) in subgroup; QOL improved in intervention group at 90 days (p = .001); 88% adherence intervention vs. 81% control (p = .003)	Nurse-directed multicomponent intervention can improve QOL, improve medication compliance, and reduce readmissions for HF patients	Patient/family	22
Sisk 2006	RCT	RN-led case management including education, medication monitoring, and teaching of self-management skills coordinated with patient’s primary MD	n = 406, 12 months, 46% AA, 33% Hispanic	Four urban hospital-based clinics	Nurse management group had fewer hospitalizations compared to controls (143 vs. 180) and better functioning (39.9 vs. 36.3) on MLwHF	Case management delivered by RNs working with patient’s primary provider can improve outcomes	Patient/family	23

Note: AA = African American; APN = advanced practice nurse; BP = blood pressure; CHF = congestive heart failure; HF = heart failure; MD = medical doctor; MLwHF = Minnesota Living with Heart Failure scale; QOL = quality of life; RCT = randomized controlled trial; RN = registered nurse.