FEASIBILITY OF A NURSE-MONITORED, OUTPATIENT-CARE PROGRAM FOR ELDERLYPATIENTS WITH MODERATE-TO-SEVERE, CHRONIC HEART-FAILURE

Aims To evaluate the feasibility of a nurse-monitored, outpatient-care program for elderly patients previously hospitalized with chronic hea rt failure. Methods and Results Patients with chronic heart failure ho spitalized in the medical wards were screened to find those eligible f or a randomized study to compare the effect of a nurse-monitored, outp atient-care programme aiming at symptom management, with conventional care. The inclusion criteria were patients classified in New York Hear t Association classes III-IV, age 65 years, and eligibility for an out patient follow-up programme. The total in-hospital population of patie nts discharged with a heart-failure diagnosis was surveyed. Eighty-nin e per cent of all the hospitalized patients (n=1541) were 65 years old . Of these, 69% (n=1058) were treated in the medical wards which were screened. The study criteria were met by 158 patients (15%). No visits to the nurse occurred in 23 cases among the 79 patients randomized to the structured-care group (29%), mainly on account of death or fatigu e. The numbers of hospitalizations and hospital days did not differ be tween the structured-care and the usual-care groups. Conclusions Given the selection criteria and the outline of the interventions, the outp atient, nurse-monitored, symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe, c hronic heart failure, mainly because of the small proportion of eligib le patients and the high drop-out rate. Management of these patients w ould have to be more adjusted to their home situation.