Impact of a heart failure nurse practitioner service on rehospitalisations, emergency presentations and survival in patients hospitalised with acute heart failure.

AIMS: Heart failure nurse practitioners (HF NP) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12 month all-cause rehospitalisations, emergency department (ED) presentations and mortality in patients hospitalised with HF compared to usual hospital care.

METHODS AND RESULTS: Retrospective, 2-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care.Among 408 patients (186 usual care; 222 HF NP service) admitted with acute HF, mean age was 76.5 (SD 12.0) years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had lower risk of 12-month rehospitalisation (61.3% vs 78.3% usual care; difference -16.9%, 95%CI: -26.4%, -6.6%) and ED presentations (12.6% vs 22.0%; difference -9.4%, 95%CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting program that was available to HF patients (64.4% vs 45.4%; difference 19%, 95%CI: 8.8%, 28.8%).

CONCLUSION: Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalisations and ED presentations over 12 months. Further evidence from a multicentre RCT is warranted.