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European Journal of Heart Failure Advance Access published online on November 18, 2009
European Journal of Heart Failure, doi:10.1093/eurjhf/hfp161
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Bridging the gap in heart failure prevention: rationale and design of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study

Melinda J. Carrington, Simon Stewart* on behalf of the NIL-CHF Study Investigators

Preventative Health, Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, VIC 8008, Australia

* Corresponding author. Tel: +61 3 8532 1640, Fax: +61 3 8532 1100, Email: simon.stewart{at}bakeridi.edu.au


  Abstract

Aims: The primary objective of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study is to develop a programme of care that cost-effectively prevents the development of chronic heart failure (CHF).

Methods: NIL-CHF is a randomized controlled trial of a hybrid, home- and clinic-based, nurse-led multidisciplinary intervention targeting hospitalized patients at risk of developing CHF. A target of 750 patients aged ≥45 years will be exposed to usual post-discharge care or the NIL-CHF intervention. The composite primary endpoint is all-cause mortality or CHF-related admission during 3–5 years of follow-up. After 12 months recruitment, ~300 eligible patients (40% of target) have been randomized. Overall, 73% are male and the mean age is 65 ± 10 years. The most common antecedents for CHF thus far are hypertension (70%, 95% CI, 64–75%), coronary artery disease (51%, 95% CI, 31–41%), and type 2 diabetes (26%, 95% CI, 21–31%), whereas 76% (95% CI, 69–82%) of patients have diastolic dysfunction, 29% (95% CI, 23–36%) left ventricular hypertrophy, 71% (95% CI, 64–78%) mitral valve dysfunction, and 7% (95% CI, 4–12%) have a left ventricular ejection fraction ≤45%.

Conclusion: As one of the largest randomized studies of its kind, NIL-CHF will ultimately provide important insights into the potential to prevent CHF via prolonged and intensive disease management.

Key Words: Chronic heart failure • Prevention • Disease management • Hypertension

Received June 5, 2009; Revised September 10, 2009; Accepted September 30, 2009


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