From beta-blockers to outcomes, the job of a CHF clinician is in the details

Handling facts is a key concept

Clinicians who care for CHF patients have to be masters of detail. There are comorbidities to consider, polypharmacy to titrate and balance, weight to watch on a daily basis, and considerations such as quality of life and functional status to assess and reassess. This issue of CHF Disease Management will show you how some of these details are affecting the clinicians who are trying to handle them.

Home care nurses, for example, were ready to jump on the CHF disease management bandwagon to demonstrate they could help patients stay in control of their disease. But after a decade of developing provincial programs representing the needs and priorities of the facilities that developed them, home care associations are calling for a standard skill set all their members should have. At stake, some say, is the future of this type of nursing that has evolved into a specialty of its own. Having an accepted set of criteria not only helps attract attention of Medicare regulators to support more home care, but can earn respect from members of the multidisciplined CHF care team.

Researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta are also calling for more attention to detail, especially when older CHF patients are about to be discharged from the hospital. Unless caregivers understand a patient’s status and support system at home, chances are good the patient will be back again all too soon. CDC researchers call for more primary preventive measures that pay attention to important details such as blood pressure and smoking so patients don’t go on to develop heart disease, while those in failure today receive the drugs and support that will keep them as healthy as possible.

And some researchers studying the details of these drugs have focused some attention to the extra features of beta-blockers.

The newer generation carvedilol, beside showing it can bring about significant clinical benefits to CHF patients, has the pharmacological effect of antioxidant activity. A team of New York scientists tested this activity against the standard metoprolol, which besides initiating a different type of beta-blockade, has not been found to have the antioxidant activity.

As the team published the report, which found no clinical differences in the two drugs for antioxidant action, it seems the public latched onto another detail it found more pressing — the comparative cost of the two drugs. The author notes that this detail was not part of the initial design of the study so conclusions should not be made about cost comparisons.

The following articles provide you with more details.