© 2004 European Society of Cardiology
Heart failure programmes in countries with a primary care-based health care system. Are additional trials necessary? Design of the DEAL-HF study
a Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, The Netherlands
b Cardiology Department Deventer Hospital, Fesevurstraat 7, 7415 CM Deventer, The Netherlands
c Cardiology Department Medical Center Alkmaar, Alkmaar, The Netherlands
d Cardiology Department Groningen University Hospital, Groningen, The Netherlands
* Corresponding author. Cardiology Department, Deventer Hospital, Fesevurstraat 7, 7415 CM Deventer, The Netherlands. Tel.: +31 570 646712; fax: +31 570 620492. E-mial address: P.Bruggink{at}dz.nl
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Abstract |
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Background: Several randomised studies of heart failure (HF) management programmes in the United States, Australia and Europe have shown a considerable reduction in hospitalisation rates for HF. In this article, a comprehensive review of these studies will be provided and their applicability to countries, with a primary care-based healthcare system, will be discussed. In addition, the design of the Deventer-Alkmaar HF Project (DEAL-HF), a randomised study of the effect of a nurse and physician-directed intervention over 1 year in The Netherlands, will also be presented.
Aim: To discuss the applicability of the results of available studies on heart failure management programmes to countries with well-structured primary care facilities and to determine whether additional trials should be conducted in these countries.
Methods: We performed a literature search in PubMed. In a review of the available studies, essential methodological aspects, in particular, the population involved, the sample size, follow-up period, setting, type of intervention, and the outcome parameters, are discussed critically. Also, the applicability of these studies to countries with a primary care-based healthcare system and easy access to medical care is evaluated.
Conclusion: Applicability of the results of the available studies on the efficacy of heart failure management programmes to countries with a primary care-based health care system is doubtful. An efficacy trial in a country with a well-established primary care-based healthcare system, such as The Netherlands, is due to report soon (DEAL-HF).
Key Words: Heart failure • HF management programmes • Education
Received May 4, 2004; Revised September 24, 2004; Accepted November 11, 2004