There is no doubt that heart failure is a major and costly health care issue. In this context, the study by Riegel et al1 is interesting. However, several weaknesses in the study and interpretation of the results mean that the findings have uncertain practical relevance in the management of heart failure.
First, there is a lack of detail on the precise activities or interventions of the nurses. Examples are mentioned in the "Patients and Methods" section, but it is all very hazy. Second, and related to the previous point, what intermediary factors were responsible for the improved outcomes? For instance, did the program result in improved prescribing of heart failure drugs, improved patient compliance with medication, or perhaps improved lifestyle management (diet and exercise)?