Effects of heart failure management programmes

摘要: Abstract of the thesis “Effects heart failure management programmes” The main purpose studies presented in this thesis, was to assess whether an intensive 1-year intervention at a clinic for patients with failure, NYHA classification III or IV, reduces incidence hospitalisation worsening and/or all cause mortality and improves functional status quality life acceptable costs observed effects may be (partly) attributable beneficial changes patient adherence drug therapy. Important differences many previous were that our directed by combination clinician nurse study performed country relatively strong primary care health-care system. In systematic review beginning results on programmes are reviewed critically their applicability countries, such as Netherlands, well-structured facilities is discussed. core chapters Deventer-Alkmaar Heart Failure (DEAL-HF study) first: number admissions all-cause deaths group lower than control (23 vs. 47; relative risk(RR) 0.49; 95% confidence interval 0.30 0.81; p= 0.001). There also improvement left ventricular ejection fraction (LVEF) (plus 2.6%) compared decrease usual (minus 3.1%; p=0.004). Patients hospitalised total 359 days, 644 days those group. Beneficial class, life, self-care behaviour health costs. Then, several sub-studies within DEAL-HF population presented. First, we assessed effect programme prescribers medication regimes: beta-blocker dosaging using spironolactone increased. This have been important contributor improved clinical outcomes. Then investigated correlation between change biochemical parameter, NT-proBNP, class during follow-up study. Long-term NT-proBNP indeed accompanied similar echo parameters. Finally studied relation effects. more detailed analysis DEAL HF confirms exerts benefit saves