Remote titration of carvedilol for heart failure patients by advanced practice nurses.

Background: beta-blockers (BB) in the treatment of heart failure (HF) are frequently underprescribed and underdosed, perhaps because of recommendations for office visits at each dose change. In previous work, we demonstrated the feasibility of remote telephonically assisted BB titration and found favorable effects on morbidity, time to target dose, and low withdrawal rates. In the current expanded evaluation, we reasoned that a structured remote telephonic titration protocol would achieve outcomes comparable to US Carvedilol Trials in regard to optimal dose, titration time, and morbidity.

Telemanagement of heart failure: a diuretic treatment algorithm for advanced practice nurses.

Thirty-three percent of patients with heart failure (HF) are readmitted to the hospital with worsening disease within 90 days of discharge. Acute decompensation accounts for nearly 50% of these admissions because of nonadherence with diet guidelines, medication regimens, or both. One way to promote adherence is through a disease management approach that can prevent HF decompensation by providing aggressive follow-up care.