RESUMEN
BACKGROUND: Clinician-assigned New York Heart Association (NYHA) class is an established predictor of outcomes in heart failure. This study aims to test whether patients' self-assessment of functional status by NYHA class predicts hospital admissions, quality of life, and mortality. METHODS AND RESULTS: This was an observational study within a randomized controlled trial. A total of 293 adult patients diagnosed with heart failure were recruited after an emergency admission at 3 acute hospitals in Norfolk, UK. Outcome measures included number of emergency admissions over 6 months, self-assessed quality of life measured with the Minnesota Living with Heart Failure questionnaire (MLHFQ) and EQ-5D at 6 months, and deaths up to 20 months' follow-up. Patients were grouped into 3 NYHA groups (I/II, III, and IV) based on patients' self-assigned NYHA class (SA-NYHA). A Poisson model indicated an increased readmission rate associated with higher SA-NYHA class (adjusted rate ratio 1.21; 95% CI 1.04-1.41; P=.02). Higher SA-NYHA class at baseline predicted worse quality of life at 6 months' follow-up (P=.002 for MLHFQ; P=.047 for EQ-5D), and was associated with higher mortality rate (adjusted hazard ratio 1.84; 95% CI 1.10-3.06; P=.02). CONCLUSIONS: SA-NYHA class is predictive of hospitalization, quality of life, and mortality among patients with heart failure.
Asunto(s)
Actitud Frente a la Muerte , Insuficiencia Cardíaca/clasificación , Insuficiencia Cardíaca/diagnóstico , Hospitalización , Calidad de Vida , Autoevaluación (Psicología) , Sociedades Médicas , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/psicología , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , New York , Valor Predictivo de las Pruebas , Pronóstico , Calidad de Vida/psicología , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients. DESIGN: Randomised controlled trial. SETTING: Home based intervention in heart failure patients. PARTICIPANTS: 293 patients diagnosed with heart failure were included (149 intervention, 144 control) after an emergency admission. INTERVENTION: Two home visits by one of 17 community pharmacists within two and eight weeks of discharge. Pharmacists reviewed drugs and gave symptom self management and lifestyle advice. Controls received usual care. MAIN OUTCOME MEASURES: The primary outcome was total hospital readmissions at six months. Secondary outcomes included mortality and quality of life (Minnesota living with heart failure questionnaire and EQ-5D). RESULTS: Primary outcome data were available for 291 participants (99%). 136 (91%) intervention patients received one or two visits. 134 admissions occurred in the intervention group compared with 112 in the control group (rate ratio=1.15, 95% confidence interval 0.89 to 1.48; P=0.28, Poisson model). 30 intervention patients died compared with 24 controls (hazard ratio=1.18, 0.69 to 2.03; P=0.54). Although EQ-5D scores favoured the intervention group, Minnesota living with heart failure questionnaire scores favoured controls; neither difference was statistically significant. CONCLUSION: This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure. Given that heart failure accounts for 5% of hospital admissions, these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits. TRIAL REGISTRATION NUMBER: ISRCTN59427925.