Nurse-led ambulatory care supported by non-invasive haemodynamic assessment after acute heart failure decompensation

The pilot phase of the AMULET project verified the usefulness of ambulatory care points (ACPs) in optimising the treatment of patients with heart failure. Visits were conducted by qualified nurses and at each, the patients had non-invasive haemodynamic tests performed by impedance cardiography with the assessment of, among other things, thoracic fluid content (TFC). The final results were evaluated by the physician and therapeutic decisions were made taking into account the haemodynamic status of the patient. Of the 73 patients included in the study (men: 75%; average age: 66 years, mean left ventricular ejection fraction: 31%) 32 were cared for immediately after hospital discharge. Analysis for the entire group showed that the patients' functional status as assessed by the NYHA classification (p = 0.013) and self-assessed health status on a 10-point scale (p = 0.002) significantly improved during the one-month care period. Nearly 50% of patients were initially overhydrated and in about 40% of patients, the therapy was modified during the following visits.

Comment from the Principal Researcher płk. dr. hab. n. med. Paweł Krzesiński: The results of the pilot phase of the study clearly support the validity of early, intensive care for patients after an episode of heart failure exacerbation. The innovative concept of ambulatory care points, where the nurse plays a central role and the use of impedance cardiography provides additional diagnostic value, was recognised by reviewers from the renowned journal ESC Heart Failure. The conclusions of the pilot confirm the validity of building a network of such care points. This is why we have developed our model focusing on telecare; we assume that the telemedicine platform created in the AMULET project will allow doctors to make therapeutic decisions remotely. This hypothesis will be verified in a randomised, prospective clinical trial involving more than 600 patients from across Poland.

The full text of the publication is freely available on the ESC Heart Failure website: 

Congratulations to the authors and to everyone involved in this phase of the project!

Krzesiński P, Siebert J, Jankowska EA, Galas A, Piotrowicz K, Stańczyk A, Siwołowski P, Gutknecht P, Chrom P, Murawski P, Walczak A, Szalewska D, Banasiak W, Ponikowski P, Gielerak G. Nurse-led ambulatory care supported by non-invasive haemodynamic assessment after acute heart failure decompensation. ESC Heart Fail. 2021 Jan 18. doi: 10.1002/ehf2.13207. Epub ahead of print. PMID: 33463072.