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 million British 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 NICE Heart Failure Guideline, July 2003

The Health Service Cost of Heart Failure

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 1 Full clinical and social assessment Information on diagnosis Contact details of HFS given Management Plan Formulated Next visit arranged Visit 2 Monitoring of clinical condition Review of medication regime/compliance Discussion of self management issues Risk factor modification Risk stratification Low Dependency High Dependency Medium Dependency Review 3-6 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 COMPLIANCE EDUCATE PATIENT AND FAMILY IMPLEMENT TREATMENT ALGORITHMS MONITOR PATIENT REDUCE RE-ADMISSIONS REDUCE COST IMPROVE QUALITY OF LIFE REDUCE MORTALITY (Gibbs, Davies and Lip 2000) Role of the HFN Aim Role 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 responsive to patients needs can make a very significant difference to the way that people experience this condition, slowing the progress of heart failure and providing sensitive and supportive care for people who are dying. Developing Services for Heart Failure Department of Health 2003

CONTACT DETAILS British Heart Foundation Heart Failure Specialist Nurse’s Jane Dudley Newark and Sherwood Ann Wilson Mansfield