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COACH-study: results of subgroup analyses-heart failure

Presenter report:
Jaarsma, Tiny (Netherlands)

The Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure (COACH) was a multicenter randomized controlled trial, in which 1023 patients were enrolled after hospitalization for HF.
Patients were assigned to one of three groups: a control group (follow-up by cardiologist), and two intervention groups with additional basic, or intensive support by a HF nurse.
Patients were studied for 18 months. Primary endpoints were time to death or rehospitalization for HF, and the number of days lost to death or hospitalization. Subgroup analysis were performed to determine possible heterogeneity in the effect of nurse-led heart failure care with regard to prespecified baseline variables.
During the study 411 patients (40%) were readmitted for HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (p=0.53).
The number of days lost to death or hospitalization was 39,960 in the control group, and it was 15% lower in the intervention groups combined (p=NS).
There was a trend towards lower mortality in the intervention groups combined (HR 0.85; 95%, p=0.18). Subgroup analyses revealed that no significant treatment x subgroup interaction was found except for an interaction between depression and all cause mortality.
Patients without depressive symptoms seem to benefit more from the basic or intensive support by a heart failure nurse compared to patients with depressive symptoms.
Further studies to determine the most optimal model for heart failure disease management are needed.




Clinical Trial Update II

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.