Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot study
Abstract Aims Heart 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 feedba...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-04-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14251 |
| _version_ | 1797857654061662208 |
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| author | Miek Smeets Willem Raat Bert Aertgeerts Joris Penders Jan Vercammen Walter Droogne Wilfried Mullens Stefan Janssens Bert Vaes |
| author_facet | Miek Smeets Willem Raat Bert Aertgeerts Joris Penders Jan Vercammen Walter Droogne Wilfried Mullens Stefan Janssens Bert Vaes |
| author_sort | Miek Smeets |
| collection | DOAJ |
| description | Abstract Aims Heart 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 results This 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. Conclusions The 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: ClinicalTrials.gov (NCT02905786), registered on 14 September 2016 at https://clinicaltrials.gov/. |
| first_indexed | 2024-04-09T21:00:14Z |
| format | Article |
| id | doaj.art-ed8f762731e043b598069b5ff0e203e3 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-09T21:00:14Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-ed8f762731e043b598069b5ff0e203e32023-03-29T11:45:20ZengWileyESC Heart Failure2055-58222023-04-0110290791610.1002/ehf2.14251Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot studyMiek Smeets0Willem Raat1Bert Aertgeerts2Joris Penders3Jan Vercammen4Walter Droogne5Wilfried Mullens6Stefan Janssens7Bert Vaes8Department of Public Health and Primary Care KU Leuven Kapucijnenvoer 7, blok D bus 7001 3000 Leuven BelgiumDepartment of Public Health and Primary Care KU Leuven Kapucijnenvoer 7, blok D bus 7001 3000 Leuven BelgiumDepartment of Public Health and Primary Care KU Leuven Kapucijnenvoer 7, blok D bus 7001 3000 Leuven BelgiumDepartment of Clinical Biology Ziekenhuis Oost‐Limburg (ZOL) Genk BelgiumDepartment of Cardiology Ziekenhuis Oost‐Limburg (ZOL) Genk BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven, KU Leuven Leuven BelgiumBiomedical Research Institute, Faculty of Medicine and Life Sciences Hasselt University Diepenbeek BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven, KU Leuven Leuven BelgiumDepartment of Public Health and Primary Care KU Leuven Kapucijnenvoer 7, blok D bus 7001 3000 Leuven BelgiumAbstract Aims Heart 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 results This 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. Conclusions The 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: ClinicalTrials.gov (NCT02905786), registered on 14 September 2016 at https://clinicaltrials.gov/.https://doi.org/10.1002/ehf2.14251Heart failureDisease management programmeGeneral practiceMultidisciplinary chronic careNatriuretic peptidesAudit and feedback |
| spellingShingle | Miek Smeets Willem Raat Bert Aertgeerts Joris Penders Jan Vercammen Walter Droogne Wilfried Mullens Stefan Janssens Bert Vaes Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot study ESC Heart Failure Heart failure Disease management programme General practice Multidisciplinary chronic care Natriuretic peptides Audit and feedback |
| title | Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot study |
| title_full | Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot study |
| title_fullStr | Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot study |
| title_full_unstemmed | Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot study |
| title_short | Mixed‐methods evaluation of a multifaceted heart failure intervention in general practice: the OSCAR‐HF pilot study |
| title_sort | mixed methods evaluation of a multifaceted heart failure intervention in general practice the oscar hf pilot study |
| topic | Heart failure Disease management programme General practice Multidisciplinary chronic care Natriuretic peptides Audit and feedback |
| url | https://doi.org/10.1002/ehf2.14251 |
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