Feasibility of evidence-based diagnosis and management of heart failure in older people in care: a pilot randomised controlled trial
1 Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen’s Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, TS17 6BH, United Kingdom
2 School of Medicine and Health, Durham University, Queen’s Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, TS17 6BH, United Kingdom
3 Department of Cardiology, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington, DL3 6HX, United Kingdom
4 Department of Cardiology, The James Cook University Hospital, South Tees Acute Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, United Kingdom
5 Department of Cardiology, North Tees Hospital, North Tees and Hartlepool NHS Foundation Trust, Hardwick Road, Stockton, TS19 8PE, United Kingdom
BMC Geriatrics 2012, 12:70 doi:10.1186/1471-2318-12-70Published: 14 November 2012
Many older people in long-term care do not receive evidence-based diagnosis or management for heart failure; it is not known whether this can be achieved for this population. We initiated an onsite heart failure service, compared with ‘usual care’ with the aim of establishing the feasibility of accurate diagnosis and appropriate management.
A pilot randomised controlled trial which randomised residents from 33 care facilities in North-East England with left ventricular systolic dysfunction (LVSD) to usual care or an onsite heart failure service. The primary outcome was the optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists at 6 months.
Of 399 echocardiographically-screened residents aged 65–100 years, 30 subjects with LVSD were eligible; 28 (93%) consented and were randomised (HF service: 16; routine care: 12). Groups were similar at baseline; six month follow-up was completed for 25 patients (89%); 3 (11%) patients died. Results for the primary outcome were not statistically significant but there was a consistent pattern of increased drug use and titration to optimum dose in the intervention group (21% compared to 0% receiving routine care, p=0.250). Hospitalisation rates, quality of life and mortality at 6 months were similar between groups.
This study demonstrated the feasibility of an on-site heart failure service for older long-term care populations. Optimisation of medication appeared possible without adversely affecting quality of life; this questions clinicians’ concerns about adverse effects in this group. This has international implications for managing such patients. These methods should be replicated in a large-scale study to quantify the scale of benefit.