introduction of a heart failure nurse practitioner clinic; impact on implementation of evidence...

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Heart, Lung and Circulation S312008;17S:S4–S53 Poster Presentations

priately and in a timely manner salvages lives for patientsin extremis.

doi:10.1016/j.hlc.2007.11.076

Nurse-led heart failure clinic in a rural setting a success

Brigitte Lindsay ∗, Ian Ternouth

Cardiology Department, Taranaki District health Board, NewZealand

Background: Nurse-led heart failure clinics elsewherehave been shown to improve patient outcomes and reducehealth costs. A semi-autonomous nurse-led cardiologistoverseen clinic in a small rural hospital was therefore setup.

Methods: A total of 107 heart failure patients admittedto the outpatient clinic were evaluated. Evaluation of theHawera Heart failure clinic (October 2003 to February2007) included examination of hospital re-admission rates,bed-days and surveys from patients, GP’s and HospitalPhysicians. Additional comments were also encouragedon the survey forms.

Results: Reductions in hospital days were shown by com-paring admissions during an equal period before and afterthe first heart failure first clinic. In this way patients actedas their own control.

Readmission rates at 3 months, 6 months and 1 yearstNi

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CHF patients often receive inappropriate managementregarding optimization of evidence based CHF medica-tions. Specialist Heart Failure (HF) nurses are integralto the success of multidisciplinary CHF programs inreducing morbidity and mortality, through improvingutilization of evidence based CHF therapy, intensive edu-cation, close monitoring and improving access to specialistservices.

Aim: A specialist HF nurse role was developed into aHF Nurse Practitioner (NP) role to improve the post dis-charge management of CHF through appropriate titrationof evidence based therapy.

Method: An audit was completed on patients attendingmore than once (39 of 68) during a 1 year period, measur-ing medication use, readmissions and self managementbehaviours. A patient satisfaction survey was mailed to 42patients, with 23 respondents.

Results: 32 of 37 (86.5%) patients had titration of beta-blocker (BB) therapy. 22 (69%) achieved target dose, 7 (22%)highest tolerated dose and 3 (9%) are continuing. Threefailed increase in BB and another failed BB completely.Appropriate BB dosing was subsequently confirmed inall cases. At referral 25 patients (78%) were on low doseand 2 (6%) on nil BB therapy. In patients with moderateto severe CHF (average ejection fraction 28%), the HFNPtitrated BB to target or highest tolerated dose, in an average3 months and 2.8 visits, demonstrating safe, effective ande(psmte

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howed 229, 153 and 118 fewer hospital days respec-ively. As one heart failure admission costs approximately

Z$3257 the results can also be translated into cost sav-ngs.

Patients reported improvements in their condition,uality of life and their ability to self-manage their heart

ailure. With one exception there was a positive responserom the GP’s and Hospital Physicians with regards to theharmacological and non-pharmacological managementf patients as well as to the inter-disciplinary teamworkhat occurred.

Conclusions: Results of the evaluation suggested positiverends with reduced morbidity and costs. Also impor-ant was the positive feedback from the intra-disciplinaryeam and patients involved. On the basis of this auditnd strength of data from clinical trials a new intra-ectoral community clinic has been set up. The clinic isun autonomously by a Prescribing Nurse Practitioner butith strong links to the cardiology department.

oi:10.1016/j.hlc.2007.11.077

ntroduction of a heart failure nurse practitioner clinic;mpact on implementation of evidence based medicationsnd patients perceptions

argaret Lucas

The Prince Charles Hospital, Australia

Background: Patients with Chronic Heart Failure (CHF)ave best outcomes under specialist care however access

o specialist services is limited. Post hospital discharge,

fficient practice. Readmission rates were low, 3 patients8%) with 9 HF and 4 (10%) with 8 non HF admissions. Theatient satisfaction survey indicated all respondents wereatisfied or very satisfied with the NP service. The com-ents reflected the HFNP service contributed positively

o the delivery of specialist HF care and to the patient’sxperience of HF care at this hospital.

oi:10.1016/j.hlc.2007.11.078

ducational interventions to improve prescribing, use ofchocardiography and provision of patient information inhronic heart failure in primary care

udith Mackson a,∗, Nancy Huang c, Sue Phillips b, Rosh-een Azam a, Emma Slaytor a, Andrew Boyden c

National Prescribing Service, AustraliaNational Institute of Clinical Studies, AustraliaHeart Foundation, Australia

Background: Accurate early diagnosis and appropriateanagement of chronic heart failure, usually the respon-

ibility of general practitioners (GPs), can significantlymprove outcomes. A Joint Program was developed toddress gaps in diagnosis and management.Methods: Multi-faceted interventions, implemented

rom October 2004 to July 2006, included active and passiveearning modules and patient information was deliveredo GPs, specialists and pharmacists. Pre and post inter-ention surveys and data from existing national databasesere used to assess the Program’s impacts and outcomes.Results: 46,000 health professionals received targeted

ducational materials by mail, and 3800 GPs (about 20% of