1. THE ROLE OF THE HEART FAILURE SPECIALIST NURSE NHS Grampian Heart Failure Nurses November 2008

2. BACKGROUND TO CHRONIC HEART FAILURE “ Chronic Heart Failure (CHF) is a common and debilitating condition” (Gould 2002, p.189). “ Chronic Heart Failure (CHF) is a common and debilitating condition” (Gould 2002, p.189). It has been described as the end stage of cardiac illness, having a worse prognosis than most cancers (Stewart et al, 2001). It has been described as the end stage of cardiac illness, having a worse prognosis than most cancers (Stewart et al, 2001). It affects about 2% of the population with approximately 63,000 new cases in the UK each year (British Heart Foundation (BHF), 2008). It affects about 2% of the population with approximately 63,000 new cases in the UK each year (British Heart Foundation (BHF), 2008).

3. BACKGROUND TO CHRONIC HEART FAILURE Prevalence is increasing due to a growing elderly population and improved medical treatments. Currently 1.5 - 2% of the population which equates to approximately 8000 patients in Grampian. Prevalence is increasing due to a growing elderly population and improved medical treatments. Currently 1.5 - 2% of the population which equates to approximately 8000 patients in Grampian. Increasing financial burden which accounts for 2% of the NHS Grampian budget. Increasing financial burden which accounts for 2% of the NHS Grampian budget. Associated with poor Quality of Life. Associated with poor Quality of Life.

4. WHAT ROLE DOES THE SPECIALIST NURSE PLAY? Recently published data from BHF has shown that a nurse led service can: Provide education and support to patients and carers. Provide education and support to patients and carers. Improve drug compliance. Improve drug compliance. Reduce hospital admissions. Reduce hospital admissions. Reduce costs to the NHS. Reduce costs to the NHS. Increase Quality of Life for patient and carer. Increase Quality of Life for patient and carer.

5. CURRENT WORKLOAD Initially, GP referral of recently discharged patients with LVSD and complex NYHA III and IV patients (confirmed on Echo). Initially, GP referral of recently discharged patients with LVSD and complex NYHA III and IV patients (confirmed on Echo). Adjustment of concomitant evidence based therapy on discussion with medical colleagues. Adjustment of concomitant evidence based therapy on discussion with medical colleagues. Education of primary care staff. Education of primary care staff.

6. PROBLEMS FOR CHF PATIENTS Confusion over changes to medication. Confusion over changes to medication. Failure to get repeat prescriptions. Failure to get repeat prescriptions. Taking non prescribed medications. Taking non prescribed medications. Poor concordance. Poor concordance. Difficult to titrate up therapy. Difficult to titrate up therapy. Poor social support. Poor social support. Depression. Depression. Poor cognitive ability. Poor cognitive ability.

7. PROBLEM AREAS Delay in GPs receiving hospital discharge letters. Delay in GPs receiving hospital discharge letters. Delay in referring to HFSN service. Delay in referring to HFSN service. Delay in updating prescription changes. Delay in updating prescription changes. Added and often intensive workload associated with up titration of therapy. Added and often intensive workload associated with up titration of therapy. Dose of diuretic requiring to be adjusted soon after discharge. Dose of diuretic requiring to be adjusted soon after discharge. Discrepancies regarding discharge therapy. Discrepancies regarding discharge therapy.

8. KEY ELEMENTS OF THE HEARTS FAILURE NURSE ROLE Regular follow up and assessment to detect early clinical deterioration. Regular follow up and assessment to detect early clinical deterioration. Adjustment and optimisation of therapy. Adjustment and optimisation of therapy. Close monitoring of blood chemistry and rapid access to results. Close monitoring of blood chemistry and rapid access to results. Education and advice about heart failure, its treatment and when to seek help. Education and advice about heart failure, its treatment and when to seek help. Encouraging patients to be actively involved in managing and monitoring their care. Encouraging patients to be actively involved in managing and monitoring their care. Providing a link between patients and other healthcare professionals and services. Providing a link between patients and other healthcare professionals and services. Supporting patients and carers with advanced heart failure. Supporting patients and carers with advanced heart failure.

9. SUPPORT NEEDED FOR HEART FAILURE SPECIALIST NURSE. Clearly defined job description. Clearly defined job description. Model of care must suit local environment. Model of care must suit local environment. Clear guidelines and care pathways for referral, admission and discharge. Clear guidelines and care pathways for referral, admission and discharge. Clear protocols and guidelines for use of evidence based drug therapy and good practice. Clear protocols and guidelines for use of evidence based drug therapy and good practice. Support from medical colleagues and multidisciplinary team. Support from medical colleagues and multidisciplinary team. Access to educational programmes and ongoing training and development. Access to educational programmes and ongoing training and development.

10. NHS GRAMPIAN HEART FAILURE SPECIALIST NURSES Moray Moray Jan Henderson - Dr Grays Hospital Mandy Davis - Community Aberdeenshire Aberdeenshire Audrey Stables – Central Siobhan Taylor – North Elizabeth Douglas - South Aberdeen City Aberdeen City Roz O’Dwyer Elaine Lee

11. FURTHER DEVELOPMENT Education about CHF and its management to primary care teams. Education about CHF and its management to primary care teams. Nurses as supplementary prescribers. Nurses as supplementary prescribers. Palliative approach both for symptom control and end of life care. Palliative approach both for symptom control and end of life care. Regular review of referral system and workload. Regular review of referral system and workload.

12. SUMMARY Patients with chronic heart failure need access to individualised care and monitoring. Given sufficient funding and support, the recruitment of effective specialist nurses, and the application of carefully constructed protocols, a heart failure service can improve the health outcome of patients with chronic heart failure. Patients with chronic heart failure need access to individualised care and monitoring. Given sufficient funding and support, the recruitment of effective specialist nurses, and the application of carefully constructed protocols, a heart failure service can improve the health outcome of patients with chronic heart failure.

13. ANY QUESTIONS?