Multidisciplinary teams more effective in heart failure
Heart failure is expensive but treatable |
Multidisciplinary interventions in heart failure — defined as those in which patient management is the responsibility of a team including a doctor and at least one of the following health care professionals: pharmacist, specialist nurse, dietician or social worker — are effective in reducing admissions to hospital and all cause mortality, according to researchers.
Richard Holland, school of medicine, University of East Anglia, and colleagues
conducted a systematic review of 30 trials. Interventions were classified
into four groups: provision of home visits; home physiological monitoring
or televideo link; telephone
follow-up but no home visits; and hospital or clinic interventions alone.
They included nurse-led programmes, medication review, medication adherence
interventions, patient education or enhanced monitoring.
The results showed that multidisciplinary interventions reduced risk
of all cause admission to hospital by 13 per cent (P=0.002), all cause
mortality by 21 per cent (P=0.002) and admission due to heart failure
by 30 per cent (P<0.001).
The effectiveness of these interventions appeared to depend on where
they were carried out, with those delivered at least partly in patients’ homes,
through visits, telephone calls or televideo techniques, being particularly
effective (Heart 2005;91:899).
In an accompanying editorial (ibid, p849) Andrew Clark and John Cleland
of Castle Hill Hospital, Hull, say that despite ample research into heart
failure, evidence suggests that it has not resulted in universal uptake
of adequate investigations, treatment and management of heart failure
patients. They suggest the current model of delivery — largely
reactive and provided by doctors — needs to be changed.
“
The role of nurses as practitioners in their own right, and the role
of pharmacists and physiotherapists have to be recognised,” they
say. They also say that there is often no systematic approach to overall
management of heart failure and call for a national service framework
for heart failure with specific targets. “What is needed is recognition
by central government that heart failure is common and expensive but
treatable.”
Valerie Ross, principal pharmacist, cardiac clinical development, Barts
and the London NHS Trust, told The Journal: “Practitioners have
access to good evidence-based medicine and guidelines; however, the management
of all aspects of heart failure remains under-resourced. Pharmacists
in primary and secondary care have a significant contribution to make
through multidisciplinary teams managing chronic
disease. Their training and experience ensures that they have the appropriate
skills for initiating, titrating and monitoring therapies in heart failure,
and ensuring the best pharmaceutical care for their patients.” |
The
Pharmaceutical Journal
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