Although much of the literature
has been devoted to programs to
improve the process of care, less
attention has been paid to the comprehensive
strategies provided by
specially trained nurses that have
improved outcomes for patients with
heart failure. When studied in the
context of multidisciplinary teams specialists contribute significantly
to improving outcomes. In a review
of 29 trials of multidisciplinary
management programs, McAlister
et al61 found that 1 of the 3 elements
crucial to a successful program is
the use of nurses who are knowledgeable
about heart failure.