A nurse-based strategy reduces heart failure morbidity in patients admitted for acute decompensated heart failure in Brazil: the HELEN-II clinical trial

Authors

  • Emiliane Nogueira de Souza,

    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
    2. Instituto de Cardiologia-Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
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  • Luis Eduardo Rohde,

    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
    2. Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Karen Brasil Ruschel,

    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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  • Cláudia Mota Mussi,

    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
    2. Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Luis Beck-da-Silva,

    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
    2. Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Andréia Biolo,

    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
    2. Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Nadine Clausell,

    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
    2. Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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  • Eneida Rejane Rabelo-Silva

    Corresponding author
    1. Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
    2. Heart Failure and Transplant Group, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
    3. Nursing School of the Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
    • Corresponding author. Escola de Enfermagem da UFRGS, Rua São Manoel, 963, Santa Cecília, Porto Alegre, RS, 90620-110, Brasil. Tel: +55 51 3359 8017, Fax: +55 51 33085436, Email: eneidarabelo@gmail.com or esilva@hcpa.ufrgs.br

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Abstract

Aims

Home-based interventions for heart failure (HF) patients might be particularly effective in middle-income countries, where social, cultural, and economic constraints limit the effectiveness of HF treatment outside the hospital environment.

Methods and results

HELEN-II was a randomized clinical trial conducted in Brazil designed to evaluate the clinical efficacy of a nurse-based strategy, started after discharge following an acute decompensated HF (ADHF) admission. HELEN-II compares the efficacy of home visits and telephone reinforcement (n = 123) with that of the conventional strategy, which is based on medical follow-up (n = 129). The primary outcome was a composite endpoint of a first visit to the emergency department (≤24 h), a hospital readmission (>24 h), or all-cause death, assessed during the first 6 months of follow-up. Most enrolled subjects were middle-aged (62 ± 13 years) males (63%) in NYHA functional class II–III (84%) with severe LV dysfunction (mean LVEF 29.6 ± 9%). The primary composite endpoint was decreased by 27% in the interventional group (relative risk 0.73; 95% confidence interval 0.54–0.99; P = 0.049). At the end of follow-up, the rate of use of the standard-of-care HF medications was similar in both groups, except for the higher use of furosemide in the interventional group. Also, HF knowledge and self-care were significantly increased in the interventional group.

Conclusions

A post-discharge, nurse-led management strategy significantly decreases the morbidity of ADHF patients in the public health system of a developing middle-income country.

Trial registration

NCT01213875

Ancillary