Raising awareness of specialist heart failure nurses and the importance of collaboration between primary and secondary care in ensuring optimal management of heart failure patients
Specialist heart failure (HF) nurses are pivotal to the delivery of robust care for the nearly one million people living with HF in the UK,1working as part of a multidisciplinary team (MDT) spanning across primary and secondary care.2
The latest chronic HF guidelines from the National Institute for Health and Care Excellence (NICE) reiterate the importance of integrated care, stating the core specialist HF MDT should contain a specialist HF nurse. This specialist HF MDT should work in close collaboration with the primary care team to ensure continuity of care and that patients are supported throughout the care pathway at diagnosis and beyond.2
HF accounts for a total of one million inpatient bed days, 2% of all NHS inpatient bed days, and 5% of all emergency medical admissions to hospital.2Underdiagnosis is a key issue, therefore, all patients with suspected HF presenting in primary care should receive a simple blood test to measure natriuretic peptide levels (e.g. NT-proBNP test), as stated in NICE guidelines.2This test indicates if symptoms are likely to be due to HF and how urgently a patient may then need referring to a HF specialist.2Despite this, 80% of HF patients are currently diagnosed in hospital as a result of an acute admission.3
Early diagnosis and having access to appropriate treatment can help manage symptoms of HF, so that people living with the condition can continue to enjoy life and live longer.4-6It is necessary to raise awareness of the importance of early diagnosis and the significance of multidisciplinary working throughout the patient pathway among the general public and health professionals.4-6 NHS England also recognises the critical importance of better HF support, with specific inclusion of a greater focus of MDTs in HF care within the NHS Long Term Plan.3 This renewed focus on HF care, and the role of the specialist HF nurse is vital.
As detailed in the NICE guidelines, the specialist HF nurse plays a key role in supporting patients through integrated care across primary and secondary care teams. As part of the specialist MDT, a HF nurse may be involved in supporting cardiologists with diagnosis, providing support and information to people newly diagnosed with HF, and supervising patients starting a new medicine. The specialist HF nurse needs to be at the centre of care to ensure optimal management for HF patients.1-2 However, the variance in the number of specialist HF nurses across the UK is becoming increasingly pertinent.
A recent audit showed that the biggest concern for HF nurses was the significant case-load that they were having to manage, and that the demand on their services was increasing without further resources.7 It is, therefore, vital that NHS care teams and commissioners recognise the importance of HF nurses within MDTs and ensure appropriate resource and funding is in place for people living with this debilitating condition.1
In this time- and resource-pressured environment, there are innovators within the HF service who are driving real change to reduce inequality in care and improve patient outcomes in the UK.
Through raising awareness of the role of the HF specialist nurse and collaborative working between primary and secondary care, NHS South Lincolnshire Clinical Commissioning Group optimised their HF services by strengthening delivery of routine care for their patient. The teams achieved this by:
This enabled them to reduce HF morbidity, mortality, hospital admissions and minimised unwarranted variation between 15 general practices across South Lincolnshire.
My involvement within the collaborative working group is to provide secondary care support to primary care colleagues in the management of chronic heart failure in our region, Julie Holroyd, consultant cardiology nurse, North West Anglia Foundation NHS Trust. The MDT hasnt increased the number of referrals to secondary care, its actually reduced the number of referrals by upskilling the GPs and giving them a forum to ask questions and build confidence.
By seeking out your nursing and clinical colleagues and sharing best practice, you can help to create a smoother and more effective HF service that can lead to optimal management of HF patients.
1. Masters J et al (2019) Increasing the heart failure nursing workforce: recommendations by the British Society for Heart Failure Nurse Forum. British Journal of Cardiac Nursing; 14: 11, 1.
2. National Institute for Health and Care Excellence (2018) Chronic Heart Failure in Adults: Diagnosis and Management. http://www.nice.org.uk/guidance/ng106
3. NHS England (2019) NHS Long Term Plan. http://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf
4. Gaggin H, Januzzi JR (2018) The past, the present, and the future of natriuretic peptides in the diagnosis of heart failure. European Heart Journal Supplements. 20(Supplement G):G11-G20.
5. Wang Y al (2015) Early detection of heart failure with varying prediction windows by structured and unstructured data in electronic health records. Conf Proc IEEE Eng Med Biol Soc; 2015: 2530-2533.
6. Morton G et al (2017) Multidisciplinary team approach to heart failure management. Heart; 104: 1376-1382.
7. Pumping Marvellous (2018) Heart Failure Nurse Audit. pumpingmarvellous.org/wp-content/uploads/2018/09/Heart-Failure-Nurse-Audit-report-2018-Final.pdf
8. Conrad N et al (2018) Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet; 391: 10120, 572-580.
This article has been funded and written by Novartis UK. Novartis has retained full editorial control.
CVM19-C027p Date of preparation: December 2019
Follow this link:
The critical role of the specialist heart failure nurse - Nursing Times