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disease management, heart failure, medication adherence, mortality, nurse-led clinics, nursing



  1. Bdeir, Bassam MD
  2. Conboy, Tara RN, BSN, MSc
  3. Mukhtar, Abdulmajid MD
  4. Omer, Hafez MD
  5. Odeh, Raed RGN, BSN
  6. Farah, Iyad RGN, MS
  7. Al-Khateeb, May RGN
  8. Tayiem, Alaa RGN
  9. Dosari, Alhanouf BSc
  10. Al Mallah, Mouaz MD, MSc, FACC, FAHA, FESC


Background: Nurse-led heart failure programs (HFPs) have been shown to reduce readmissions and improve medication adherence rates. However, their impact on survival is not well demonstrated.


Objective: The purpose of this study was to evaluate the impact of a nurse-led HFP on all-cause mortality.


Methods: This retrospective review included 413 consecutive patients who were admitted with heart failure exacerbations in 2008 and 2009. All patients were invited to attend a nurse-led HFP; 199 (48%) patients agreed and were compared with the 214 (52%) who chose usual care. Patients were followed for all-cause mortality, which was confirmed by the national death index. Independent predictors of outcomes were identified using multivariable Cox regression.


Results: Patients followed in the HFP were younger, more often men with lower ejection fraction, blood urea nitrogen, and systolic blood pressure. After a median follow-up of 15 months (range, 6-30 months), a total of 55 patients died: 14 in the HFP group (7%) compared with 41 patients (19%) in the usual care group. Participation in the HFP was independently associated with reduction in all-cause mortality (hazard ratio, 0.4; 95% confidence interval, 0.2-0.8; P = .008).


Conclusions: Our nurse-led HFP was independently associated with improved survival among patients with decompensated heart failure. Further research is required to confirm this finding.