A Multifaceted Nurse-based Strategy Reduces HEart FaiLure Morbidity in PatiENts Admitted for Acute Decompensated Heart Failure in Brazil
A Multifaceted Nurse-based Strategy Reduces HEart FaiLure Morbidity in PatiENts Admitted for Acute Decompensated Heart Failure in Brazil
The home based intervention is a multidisciplinary approach that has shown benefit in the
 follow-up of patients with Heart Failure (HF). It is considered one of the most effective
 approaches and humanized by education and care for the patient in his environment of routine.
 In this study the monitoring of HF patients in the home after hospital discharge will include
 the reinforcement, monitoring and reassessment of previously provided guidance on the disease
 and self-care, compliance to prescribed medications and especially the early recognition of
 signs and symptoms of decompensation by patients and their caregivers.
The epidemiological picture of cardiovascular disease in which the IC sets itself as the
 leading cause of readmissions in the National Health System and that has not changed over the
 years, undertake the management of the limited resources of the public health system.
 Moreover, the IC contributes to significant loss of quality of life of patients, many in
 socially productive ages resulting in absenteeism and early retirement. This study aims to
 evaluate the impact of home monitoring, intercalated with telephone contact by the nursing
 staff at the HF patients, after hospital discharge in relation to the rate of hospital
 readmissions, compliance and cost-effectiveness this intervention, compared to conventional
 monitoring of patients within 6 months without this intervention, as well as building a
 structure that allows the use computerized forms of assessment in nursing in cardiology by
 mobile technology, assess the knowledge of the disease and the skills to self-care; assess
 compliance, assess the quality of life, linking the sociodemographic characteristics and
 clinical with adherence to treatment and rates of readmission in both groups, and check the
 cost of home monitoring. For this purpose, a randomized clinical trial was designed in two
 centers, blinded to outcomes and costs of readmission.

 Summary of the study:

 The home based intervention is a multidisciplinary approach that has shown benefit in the
 follow-up of patients with Heart Failure (HF). It is considered one of the most effective
 approaches and humanized by education and care for the patient in his environment of routine.
 In this study the monitoring of HF patients in the home after hospital discharge will include
 the reinforcement, monitoring and reassessment of previously provided guidance on the disease
 and self-care, compliance to prescribed medications and especially the early recognition of
 signs and symptoms of decompensation by patients and their caregivers.

 Detailed description: The epidemiological picture of cardiovascular disease in which the IC
 sets itself as the leading cause of readmissions in the National Health System and that has
 not changed over the years, undertake the management of the limited resources of the public
 health system. Moreover, the IC contributes to significant loss of quality of life of
 patients, many in socially productive ages resulting in absenteeism and early retirement.
 This study aims to evaluate the impact of home monitoring, intercalated with telephone
 contact by the nursing staff at the HF patients, after hospital discharge in relation to the
 rate of hospital readmissions, compliance and cost-effectiveness this intervention, compared
 to conventional monitoring of patients within 6 months without this intervention, as well as
 building a structure that allows the use computerized forms of assessment in nursing in
 cardiology by mobile technology, assess the knowledge of the disease and the skills to
 self-care; assess compliance, assess the quality of life, linking the sociodemographic
 characteristics and clinical with adherence to treatment and rates of readmission in both
 groups, and check the cost of home monitoring. For this purpose, a randomized clinical trial
 was designed in two centers, blinded to outcomes and costs of readmission.

 Intervention: There will provided education about what is heart failure, its causes, how to
 recognize signs and symptoms, monitoring of weight and blood pressure, the importance of
 compliance to treatment. Patients will be instructed about the medications they are using. A
 guide to rest and exercise, sexual activity, vaccines, travel and diet (water and salt
 restriction) will be provided. The involvement of the family will be encouraged and
 reinforced at every home visit. The contact with the team should be done when: patient
 observes an increase of 1 or 2 kg of weight in 2-3 days, worsening of dyspnea on effort,
 edema in legs / abdomen, worsening of cough, persistent vomiting, syncope, sputum with blood,
 fever, persistent tachycardia, motor deficit / paralysis and / or unexplained chest pain. In
 phone calls made between home visits, the compliance to treatment will be evaluated and
 reinforced.
Inclusion Criteria:

 -  Patients of both sexes, aged 18 years or above, with a diagnosis of heart failure with
 systolic dysfunction (ejection fraction ≤ 45%), hospitalized for decompensation of HF

 -  Who agree to participate in the study by signing the Informed Consent.

 Exclusion Criteria:

 -  Patients with communication disabilities and people with degenerative neurological
 diseases.

 -  Are also excluded patients who presented acute coronary syndrome (ACS) in the last 6
 months before randomization

 -  Patients with renal, hepatic, pulmonary or systemic disease that may confuse the
 interpretation of the findings or result in limited life expectancy

 -  Surgical plan or therapeutic that might influence the follow-up

 -  Pregnancy, diagnosis of acute heart failure secondary to:

 -  sepsis

 -  myocarditis

 -  myocardial infarction

 -  acute peripartum and other cause

 -  Have no interest in receiving home visits

 -  Living at a distance greater than 10 km from the hospital of origin

 -  Not be able to contact by telephone.