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Title: | Mixed-methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR-HF pilot study | Authors: | Smeets , Miek Raat, Willem Aertgeerts, Bert PENDERS, Joris Vercammen, Jan Droogne, Walter MULLENS, Wilfried Janssens , Stefan Vaes, Bert |
Issue Date: | 2023 | Publisher: | WILEY PERIODICALS, INC | Source: | ESC Heart Failure, 10 (2) , p. 907 -916 | Abstract: | AimsHeart failure (HF) is an important health problem for which multidisciplinary care is recommended, yet few studies involve primary care practitioners in the multidisciplinary management of HF. We set up a multifaceted prospective observational trial, OSCAR-HF, piloting audit and feedback, natriuretic peptide testing at the point of care, and the assistance of a specialist HF nurse in primary care. The aim was to optimize HF care in general practice. Methods and resultsThis is an analysis at 6 month follow-up of the study interventions of the OSCAR-HF pilot study, a nonrandomized, noncontrolled prospective observational trial conducted in eight Belgian general practices [51 general practitioners (GPs)]. Patients who were assessed by their GP to have HF constituted the OSCAR-HF study population. We used descriptive statistics and mixed-effects modelling for the quantitative analysis and thematic analysis of the focus group interviews. There was a 10.2% increase in the registered HF population after 6 months of follow-up (n = 593) compared with baseline (n = 538) and a 27% increase in objectified HF diagnoses (baseline n = 359 to 456 at T6 M). Natriuretic peptide testing (with or without referral) accounted for 54% (n = 60/111) of the newly registered HF diagnoses. There was no difference in the proportion of patients with HF with reduced ejection fraction who received their target dosage of renin-angiotensin-aldosterone system inhibitors or beta-blockers at 6 months compared with baseline (P = 0.9). Patients who received an HF nurse intervention (n = 53) had significantly worse quality of life at baseline [difference in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score 9.2 points; 95% confidence interval (CI) 4.0, 14] and had a significantly greater improvement in quality-of-life scores at the 6 month follow-up [change in MLHFQ score -9.8 points; 95% CI -15, -4.5] than patients without an HF nurse intervention. GPs found audit and feedback valuable but time intensive. Natriuretic peptides were useful, but the point-of-care test was impractical, and the assistance of an HF nurse was a useful addition to routine HF care. ConclusionsThe use of audit and feedback combined with natriuretic peptide testing was a successful strategy to increase the number of registered and objectified HF diagnoses at 6 months. GPs and HF nurses selected patients with worse quality-of-life scores at baseline for the HF nurse intervention, which led to a significantly greater improvement in quality-of-life scores at the 6 month follow-up compared with patients without an HF nurse intervention. The interventions were deemed feasible and useful by the participating GPs with some specific remarks that can be used for optimization.Trial Registration: (NCT02905786), registered on 14 September 2016 at . | Notes: | Smeets, M (corresponding author), Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Kapucijnenvoer 7,Blok D Bus 7001, B-3000 Leuven, Belgium. miek.smeets@kuleuven.be |
Keywords: | Heart failure;Heart failure;Disease management programme;Disease management programme;General practice;General practice;Multidisciplinary chronic care;Multidisciplinary chronic care;Natriuretic peptides;Natriuretic peptides;Audit and feedback;Audit and feedback;Primary care;Primary care | Document URI: | http://hdl.handle.net/1942/42036 | ISSN: | 2055-5822 | e-ISSN: | 2055-5822 | DOI: | 10.1002/ehf2.14251 | ISI #: | 001119955800001 | Rights: | 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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