The expanding role of Nurse Practitioners in optimizing heart failure treatment

Background

Achieving optimal care for heart failure (HF) remains challenging in clinical practice, with a significant proportion of HF patients not receiving guideline-recommended treatments.

Objectives

This study aimed to assess the role of Nurse practitioner (NP)-Enhanced Therapeutic Management on therapeutic management after discharge of patients hospitalized for acute HF.

Methods

We studied 187 consecutive patients hospitalized for acute HF with LVEF < 50% in our Cardiology department in 2022–2023. Patients were analyzed whether they underwent a classic follow-up by a cardiologist alone or a cardiologist associated with a NP, who was qualified to provide patient education and adjust heart failure medications. The association of NP-enhanced follow-up on HF medication dosages (assessed via the KCMO score) and the composite outcome of all-cause mortality and HF readmission was evaluated at the first post-discharge consultation and 6 months later.

Results

Fifty-five patients underwent combined monitoring by NPs and cardiologists and 132 monitoring by cardiologists alone. KCMO score progression was significantly more important in the “NP + cardiologist group” (ΔKCMO 11.5 vs 1.4 with a mean difference of 9.83 [3.01 to 16.65]; P = 0.005). Patients in the “NP + cardiologist” monitoring group received more non-pharmacological care for HF, including home-visiting programs (94.5% vs 34.4%; P < 0.0001), telemonitoring (83.6% vs 16.2%; P < 0.0001), and therapeutic patient education (43.6% vs 6.1%; P < 0.0001), compared to usual follow-up. Composite criteria was 50% lower in the “NP + cardiologist” group six months after discharge (HR, 0.50 [95% CI, 0.27–0.93]; P = 0.028) (Figure 1, Figure 2, Figure 3).

Conclusion

NP-enhanced management is associated with a more rapid up-titration of HF GDMT and higher inclusions in non-pharmaceutical care programs six months after discharge for acute HF.