Outcomes/Effectiveness Research

Nurse-led care improves functioning for patients with heart failure in minority communities

Patients with heart failure whose care is directed by nurse managers perform everyday activities better and have fewer hospitalizations than patients who self-manage their own care, according to a study funded by the Agency for Healthcare Research and Quality (HS10402). Heart failure is a condition in which the heart becomes too weak to adequately deliver oxygen-rich blood throughout the body. Over time this condition can cause a buildup of fluid or congestion in the lungs and other body tissues.

Researchers led by Jane Sisk, Ph.D., of Mount Sinai School of Medicine and currently at the Centers for Disease Control and Prevention's National Center for Health Statistics, enrolled 406 heart failure patients, about one-half African American and one-third Hispanic, from ambulatory practices affiliated with Harlem, NY hospitals. The patients were randomly assigned to a nurse-management group or a usual-care group. By 9 months, nurse-managed patients reported only slight limitations in their physical functioning, while self-managed patients reported marked limitations. This difference persisted through the 12-month intervention period. Also, the nurse-managed patients had fewer hospitalizations at 12 months, 143 vs. 180 for the usual-care patients.

The nurses counseled patients on the signs and symptoms of heart failure, benefits of a low-salt diet, and the importance of taking prescribed medications. Also, the nurses arranged any medication changes and tests with the patients' clinicians, who remained in charge of the patients' care. Patients in the usual-care group received only Federal consumer guidelines for managing their condition but no other intervention.

The percentage of patients hospitalized at least once, number of emergency department visits, and medications prescribed did not differ between the groups. After 12 months, when the nurses were no longer counseling the patients, researchers found that the nurse-led patients' functioning began decreasing at a rate similar to that of patients who had received no counseling at all.

Mount Sinai Medical Center and North General Hospital, a nearby community hospital, are continuing this nurse-management treatment through the Alliance for Health Improvement, an organization created in part to develop health improvement programs in Harlem. Under an arrangement with the State of New York that increased the State's Medicaid payments for clinical care, these hospitals agreed to undertake activities to improve the quality of care, and the Alliance's heart failure nurse-management program enrolled its first patient in September 2005. Building on the results of this study, nurses in the new program will work with patients beyond 12 months. This heart failure program is the first quality improvement activity for the Alliance for Health Improvement.

More details are in "Effects of nurse management on the quality of heart failure care in minority communities," by Dr. Sisk, Paul L. Hebert, Ph.D., Carol R. Horowitz, M.D., M.P.H., and others, in the August 15, 2006, Annals of Internal Medicine 145(4), pp. 273-283.

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