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Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial
  1. Rickard Markgren1,
  2. Margareta Brännström2,
  3. Claes Lundgren3 and
  4. Kurt Boman4
  1. 1Internal medicine clinic, St Göran hospital, Stockholm, Sweden. At the time of writing the article at Internal medicine clinic, Skellefteå hospital, Skellefteå, Sweden
  2. 2Department of Nursing, Strategic Research Program in Health Care Sciences (SFO-V), “Bridging Research and Practice for Better Health”, Umeå University, Umeå, Sweden
  3. 3Palliative Care Unit AHS, Skellefteå Hospital, Skellefteå, Sweden
  4. 4Research unit, Department of Medicine, Skellefteå, Institution of Public Health and Clinical, Medicine, Umeå University, Umeå, Sweden
  1. Correspondence to Professor Kurt Boman, Department of Medicine, Research unit, Skellefteå Hospital, Skellefteå 93186, Sweden; kurt.boman{at}vll.se

Abstract

Objective Patients with chronic heart failure (CHF) may be insufficiently treated pharmacologically. Recently, we presented a person-centred integrated Palliative advanced homecaRE and heart FailurE caRe (PREFER) strategy and compared it with usual care (control). Patients managed according to PREFER had improved health-related quality of life and markedly reduced hospitalisations compared with the control group. We hypothesised that these improvements may have been partly due to better drug treatments within the PREFER strategy. Thus, our aim in this study was to explore the management of drug treatments in the PREFER group compared with the control group.

Methods Doses and numbers of drugs and the number of patients receiving the target doses based on current guidelines were measured and compared between the groups at the start and finish of the study.

Results The percentages of ACE inhibitors (ACEIs) or mineralocorticoid receptor antagonists (MRAs) increased, while loop diuretics decreased in the PREFER arm during the study, although the differences were not significant. Beta-receptor blockers (BBs) decreased somewhat in both groups. The number of patients treated with MRAs differed the most between groups, and increased from 10 (28%) to 15 (48%) in the PREFER arm compared with 13 (35%) vs 13 (39%) in the control group. The change in patients receiving full target doses (+8 vs. +1) of the ACEIs/angiotensin receptor blockers, BBs and MRAs were significantly higher (p=0009) in the PREFER arm than in the control arm.

Conclusions Person-centred integrated care of patients with severe CHF was associated with increased evidence-based drug treatments, especially MRAs.

Clinical trial number NCT01304381.

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  • Received 23 March 2015.
  • Revision received 2 November 2015.
  • Accepted 17 December 2015.
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