[Comparison between telephone and outpatient nursing management in patients with chronic heart failure in a large territorial area in Piedmont, Italy].

Background: In the last years, the increasing incidence and prevalence, the deterioration of quality of life, the high mortality and the elevated costs related to chronic heart failure represent one of the most important problems of public health care. Multidisciplinary management systems based on specialized nurses teams improve the outcome and reduce the costs of care of these patients. The aim of this study was to analyze the use for 1 year, in an urban or suburban population, of two different nurse-based management systems in addition to usual care for outpatients with congestive heart failure.

Methods: We enrolled 102 patients: group A (n = 49) was followed up with a phone-nurse-based system and group B (n = 53) was followed up with a nurse ambulatory system.

Results: An improvement in NYHA class was observed in both groups (group A: NYHA class I-II 31 to 38 patients, NYHA class III-IV 18 to 7 patients, p = 0.03; group B: NYHA class I-II 37 to 43 patients, NYHA class III-IV 16 to 6 patients, p = 0.03). An improvement was also observed in the Minnesota Living with Heart Failure Questionnaire (group A: 25 +/- 10 to 15 +/- 9; p <0.01; group B: 29 +/- 13 to 20 +/- 10; p <0.01), and in ejection fraction (group A: from 31 +/- 9 to 37 +/- 12%; p <0.01; group B: from 30 +/- 9 to 35 +/- 13%; p = 0.02). No significant differences were found between the two groups in mortality, hospital readmission, emergency room and day-hospital admissions.

Conclusions: Our results confirm the effectiveness of a monitoring management and educational system for heart failure patients. A phone-nurse-based system requires minor staff and has a better flexibility than a nurse ambulatory system; the latter, however, leads to a professional and human complete interaction as well as enables rapid intervention of the cardiologist in case of instability.