Safety and Effectiveness of Drug up Titration by Nurses Specialized in Heart Failure (HF) Patients
Safety and Effectiveness of Drug up Titration by Nurses Specialized in Heart Failure (HF) Patients
Introduction: Heart Failure (HF) generates multiple hospital admissions and mortality, which
 are reduced with the administration of Beta-Blocker (BB), Angiotensin Converting Enzyme
 Inhibitor (ACEI), Angiotensin II Receptor Blocker (ARB) and Mineralocorticoid Receptor
 Antagonist (MRA) drugs (Level of Evidence A). The effect is dose-dependent. Nevertheless,
 dosages are suboptimal. European Guidelines 2012 recommend close monitoring and up-titration
 of drugs by HF nurses. Trials are needed to evaluate their effectiveness and safety.
 Objective: To compare doses achieved by patients of BB, ACEI, ARB II and MRA in 4 months ( %
 relative to target doses) in the intervention group (HF nurse) and in the control group (
 cardiologist), adverse events, Left Ventricular Ejection Fraction (LVEF), New York Heart
 Association (NYHA), 6 min. walking test, quality of life, Nt-proBNP, readmissions and
 mortality. Hypothesis: Non-inferiority. Design: Multicenter randomized controlled trial. New
 ("de novo") HF patients with LVEF ≤ 40%, NYHA II-III, without contraindications to BB of 17
 Spanish hospitals will be included. Intervention: The cardiologist prescribes drugs and,
 driven by protocol, the HF nurse implements the up-titration. In the control group doses are
 decided by the cardiologist clinical support and education being provided by nurses.
 Variables: age, sex, education, psycho-social level, Cardio Vascular Risk Factors (CVRF),
 NYHA, LVEF, ischemic cardiopathy., N-terminal pro B-type natriuretic peptide (Nt-proBNP),
 6min. walking test, Creatinine/Glomerular Filtration Rate (GFR), Potassium (K), haemoglobin,
 Blood Pressure (BP), Heart Rate (HR), mg./drug, European Heart Failure Self-Care Behaviour
 Scale (EHFScBS), Minnesota Living with Heart Failure questionnaire (MLHFQ), European Quality
 of life Scale (EQ-5D). Expected Results: If our hypothesis were confirmed, evidence would be
 provided on the effectiveness of this healthcare management, that could be economically
 evaluated in future studies. A qualitative study also will be undertaken to explore barriers
 and facilitators to implementation
No apply
Inclusion Criteria:

 -  Patient with "de novo" heart Failure and LVEF <= 40% admitted in hospital, without
 contraindications for BB prescription with cardiologist up-titration prescription and
 without having achieved BB target dose previous discharge and signing informed
 consent.

 Exclusion Criteria:

 -  Contraindications for BB.

 -  Living in a nursing home.

 -  Life expectancy < 6 months.

 -  Unable to self-care or mental disease without caregiver.

 -  Unable to weight

 -  Without phone

 -  Unable to go to clinic visit.