Effects of a nurse-based heart failure clinic on drug utilization and admissions in a community hospital setting

Objective. To evaluate the effect of a nurse-led heart failure clinic on drug therapy and hospitalization in a community hospital setting. Design. Prospective, observational study of outpatients referred to a heart failure clinic. Nurses directed drug uptitration and delivered patient education. Utilization and doses of ACE inhibitors and beta-blockers were analyzed as were heart failure related admissions in the years before and after establishing the clinic. Results. 138 patients (median age 68.5 years) were enrolled. After three months 94% of patients were taking an ACE inhibitor and beta-blockade was prescribed for 91%. Mean ACE inhibitor dose relative to target dose after three months was 779/30% and mean beta-blocker dose was 539/31% of the target dose. Heart failure admissions decreased by 45% after the clinic was established. Conclusions. Community hospital based heart failure clinics may promote utilization of evidence based drug therapy and cause a substantial decrease in heart failure admissions, producing results comparable to those obtained in studies of university hospital based heart failure management programs.