The findings, which appear in the Oct. 19 issue of Annals of Internal Medicine, are at odds with past studies that show substantial benefits to specialized care management. The authors suggest that nurse care management does not measurably improve the health of clinically low-risk heart failure patients who, like the ones in this study, are receiving comprehensive health care.
"Nurse care management holds tremendous promise for patients at higher risk or those not receiving comprehensive care, but that doesn't mean it's universally effective," said Robert F. DeBusk, MD, professor of medicine (cardiovascular medicine) and lead author of the study.
Heart failure is the leading cause of hospitalization in people age 65 or older. It is a chronic ailment in which the heart loses some of its pumping capacity, though it may keep beating normally. It differs from heart attack, in which blood flow to the heart muscle itself is restricted.
DeBusk and his team studied 462 patients receiving treatment for heart failure at five Kaiser Permanente hospitals in the San Francisco Bay area. Half of the participants received nurse care management. Nurses at Stanford phoned these patients 16 times during the yearlong study to instruct them about their condition and check that they were taking the appropriate medications. All participants received the usual follow-up care provided by their own doctor.
"The idea is that if you give patients information on how to manage their illness, they will do it," said DeBusk. That's what previous studies of nurse care management conducted by DeBusk's
Contact: Mitzi Baker
Stanford University Medical Center