Heart Failure Nurse-Led Titration of Heart Failure Medicines

Summary

A Cochrane review [Abstract] 1 included 7 studies with a total of 1 684 subjects with heart failure with reduced ejection fraction (HFrEF). Studies compared heart failure nurse-led titrating (NLT) of beta-adrenergic blocking agents, ACEIs, and/or ARBs with usual care, in which participants were under the management of a primary care physician who was responsible for titration of ACEIs, ARBs, and/or beta-adrenergic blocking agents. NLT refers to heart failure nurse specialist or nurse practitioners visiting the patient at home or in an outpatient clinic. The heart failure nurses have been delegated the responsibility for making protocol-led changes in the dosage of beta-adrenergic blocking agents, ACEIs, and ARBs. One study enrolled participants from a residential care facility, and the other 6 studies from primary care and outpatient clinics.

Participants in the NLT group experienced a lower rate of all-cause hospital admissions and fewer hospital admissions related to heart failure compared to the usual-care group. All-cause mortality was also lower in the NLT group. Approximately 27 deaths could be avoided for every 1000 people receiving NLT of beta-adrenergic blocking agents, ACEIs, and ARBs. Participants in the NLT group were more likely to remain event free and more likely to reach target dose of beta-adrenergic blocking agents compared to participants in the usual-care group. Participants in the NLT group reached maximal dose of beta-adrenergic blocking agents in half the time compared with participants in usual care.

Two studies reported on adverse events; one of these studies stated there were no adverse events, and the other study found one adverse event but did not specify the type or severity of the adverse event.