Commentary

Heart failure carries a poor prognosis for patients and places substantial demands on health services. The study by Blue et al provides evidence that outcomes for patients with severely disabling heart failure can be improved by a nurse led intervention for patients and families, delivered through home visits, telephone contact, and printed material.

The intervention, which focused on patient education, optimising management (drugs, diet, and exercise), treatment adherence, self monitoring, and psychological support, reduced hospital readmissions for heart failure. The use of the term specialist nursing intervention in the title may be slightly misleading. Correspondence with the authors confirmed that staff nurses on a cardiology unit carried out the intervention. They were given a few weeks of training in the management of heart failure and the use of protocols to manage drug regimens.

This study provides food for thought for clinical teams. The low number needed to treat of 6 suggests that individual patients have a good chance of benefiting from such an intervention. The addition of some form of home visiting to review progress and compliance of patients with heart failure has now been shown to be effective in several studies.^1,2 The fact that the intervention was implemented by staff nurses who required comparatively little training suggests the possibility of widespread applicability to general medical wards. Even if home visiting is not possible for ward staff, optimisation of treatment regimens in hospital and home visits by community nursing staff would likely achieve the same objectives.