Nurse-led titration models of care for heart failure reduced ejection fraction: A systematic narrative review of characteristics, patient outcomes, and healthcare resource utilisation

Abstract Background Nurse-led titration (NLT) models of care assist with delivery of guideline directed medical therapy for patients with heart failure with reduced ejection fraction (HFrEF). Effectiveness of NLT is established but there is limited information of characteristics of models, patient outcomes and healthcare resource utilisation. Aim: To build upon the existing evidence by providing a systematic narrative review of the literature of NLT of medications for patients with HFrEF. This review syntheses characteristics of NLT models of care, patient outcomes and healthcare resource utilisation. Methods and Results A systematic narrative literature review with systematic search strategy, identification of results, thematic analysis and narrative synthesis. A search was conducted from 2012-2025 in Medline, Cinahl complete, Embase and Cochrane. Sixteen studies of nurse-led titration models of care were identified from 1,944 screened records. Characteristics of models of care were participation of nurses, multidisciplinary teams, follow up and common features of service delivery. Patient outcomes of mortality were favourable for those that received NLT. There is some evidence of changes in healthcare resource utilisation; studies in which the NLT groups received more HF nurse visits and greater HF medication use also reported reduced rehospitalisations. Conclusion Findings reinforce the published benefits of nurse-led titration. Additional studies examining adverse events and quality-of-life outcomes are needed to strengthen the evidence base. Several studies suggest a shift in resource use with NLT, highlighting the need for an economic evaluation to inform a cost-effective model of care.