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Feasibility of evidence-based diagnosis and management of heart failure in older people in care: a pilot randomised controlled trial

Hancock, HC; Close, H; Mason, JM; Murphy, JJ; Fuat, A; de Belder, M; Hunt, T; Baker, A; Wilson, D; Hungin, A Pali S

Feasibility of evidence-based diagnosis and management of heart failure in older people in care: a pilot randomised controlled trial Thumbnail


Authors

HC Hancock

H Close

JM Mason

JJ Murphy

A Fuat

M de Belder

T Hunt

A Baker

D Wilson

A Pali S Hungin



Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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. Trial registration: ISRCTN19781227 http://www.controlled-trials.com/ISRCTN19781227

Citation

Hancock, H., Close, H., Mason, J., Murphy, J., Fuat, A., de Belder, M., …Hungin, A. P. S. (2012). Feasibility of evidence-based diagnosis and management of heart failure in older people in care: a pilot randomised controlled trial. BMC Geriatrics, 12, Article 70. https://doi.org/10.1186/1471-2318-12-70

Journal Article Type Article
Acceptance Date Oct 22, 2012
Publication Date Nov 14, 2012
Deposit Date Dec 4, 2012
Publicly Available Date Mar 29, 2024
Journal BMC Geriatrics
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 12
Article Number 70
DOI https://doi.org/10.1186/1471-2318-12-70
Keywords Chronic heart failure, Treatment outcomes, Randomised controlled trial, Older people, Long-term care.

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