Delivering Evidence Based Heart Failure Care

Jane Dudley

Heart Failure Specialist Nurse

Learning Outcomes Define the term heart failure. understand the role of the specialist nurse

in caring for patients with this long term condition.

Have a basic understanding of medical and non medical management.

Have an understanding of worsening symptoms and report any change in symptoms to appropriate healthcare professional eg, HF Specialist Nurse, District Nurse, Community Matron.

■ In the UK there are about 63,000 new cases of heart failure each year

■ Currently about 878,000 people in UK have definite or probable heart failure

Heart failure has a poor prognosis - 40% of people diagnosed with heart failure die within a year.

■ Survival rates similar to those from cancer of the colon, worse than those from cancer of the breast, uterus, bladder and prostate.

Impact of Heart Failure

■ It is estimated that over 5% of all deaths in the UK are due to heart failure.

■ People with heart failure have a lower quality of life than people with arthritis, chronic lung disease or angina.

■ In England 2% of all inpatient bed days are due to heart failure. This is projected to increase by 50% over the next 25 years.

■ Annual cost of heart failure to the National Health Service in the UK is about £625 millionBritish Heart Foundation 2008

NYHA CLASSES NYHA I: Asymptomatic

No limitation

NYHA II: Mild

Slight limitation in physical activity

Comfortable at rest, slightly SOBOE

NYHA III: Moderate

Marked limitation of physical activity

NYHA IV:Severe

Unable to carry out physical activity without

symptoms . Symptoms of breathlessness at

rest

Morbidity and mortality for all grades of

symptomatic chronic heart failure are high.

20-30% 1 year mortality in mild to moderate

heart failure ( class 11 – 111 )

50% + 1 year mortality in severe heart failure ( class 1V )

Overall survival at 8 years for all classes is approx 30%

Gibbs, Davies & Lip 2000

The NSF Goal

Every primary care team should ensure that all

those with heart failure are receiving a full package

of appropriate investigation and treatment,

demonstrated by clinical audit data not more than

12 months old

Available at www.nice.org.uk

NICE Heart Failure Guideline, July 2003

The Health Service Cost of Heart Failure

Drugs9%

Outpatient investigations6%

Primary Care17% Inpatient care

60%

OPD care8%

Aims Bridge the gap between primary and

secondary care Patient and carer focused To optimise the management and improve the

quality of life experienced Prevent unnecessary hospitalisations Patient journey as smooth as possible and not

fragmented Proactive intervention rather than reactive

response.

Referral Criteria - Who is seen?

Patients with echocardiography / angiography evidence of LVSD who

are:

Experiencing decompensating heart failure at home or in hospital.

Failing to comply with therapy.

Not on optimal treatment regimes

Exclusion Criteria

Unwilling to have support.

Other immediate life threatening illness.

History of abusive behaviour towards health care professionals.

Patient referred to HFS

Visit 1Full clinical and social assessment

Information on diagnosisContact details of HFS given

Management Plan FormulatedNext visit arranged

Visit 2Monitoring of clinical condition

Review of medication regime/complianceDiscussion of self management issues

Risk factor modificationRisk stratification

Low Dependency

High DependencyMedium Dependency

Review3-6 months/Open Appt

Review 1-12 weeks

Review 1-6 weeks

Patient Education

Heart failure and its management Medication Daily weight monitoring Early symptom recognition Importance of diet/fluid restriction Lifestyle changes Need for immunisation

HEART FAILURE NURSE

PROMOTE COMPLIANCEEDUCATE PATIENT

AND FAMILY

IMPLEMENT TREATMENT ALGORITHMS

MONITOR PATIENT

REDUCE RE-ADMISSIONS

REDUCE COST

IMPROVE QUALITYOF LIFE

REDUCE MORTALITY

(Gibbs, Davies and Lip 2000)

Role of the HFN

Aim

Role of Heart Failure NurseRole of Heart Failure Nurse

General Advice Immunisations

Annual influenza Single pneumoccocal

Sufficient medication for holidays Palliative care support throughout

the course of the disease Management of gout, anxiety, pain, nausea

and fatigue

Benefits to the Health Community

standards of care for heart failure patient enhanced

improved liaison between Primary and Secondary Care

provides a resource for health care professionals

Impact Of Heart Failure Services

Supported by BHF, funded by Big Lottery Fund (2004). 76 HFSN’s were employed by PCTs in England. (University of York Research)

Main Findings Average reduction in HF admissions

43% Average reduction in all cause

admissions 35% Average Length of stay 11.6 nights.

Main Findings Average proportion of patients in

the PCT discharged with coding of HF seen by HFSN’s 34%.

Average estimated saving per patient £1,826

Estimated saving to the PCT if nurse sees 100 pts per year over and above cost of salary £182,600.

Effective local services which are Effective local services which are responsive to patients needs can make responsive to patients needs can make a very significant difference to the way a very significant difference to the way that people experience this condition, that people experience this condition, slowing the progress of heart failure and slowing the progress of heart failure and providing sensitive and supportive care providing sensitive and supportive care for people who are dyingfor people who are dying..

Developing Services for Heart FailureDeveloping Services for Heart FailureDepartment of Health 2003Department of Health 2003

CONTACT DETAILS British Heart Foundation Heart Failure Specialist Nurse’s

Jane Dudley 07766656598 Newark and Sherwood Ann Wilson 07766656683 Mansfield