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Grace Williams, Alison Bentley, Tina Lawton & Sue Duggan Heart Failure • Complex syndrome caused by impaired cardiac function • Two types: • left ventricular systolic dysfunction (LVSD) • heart failure with preserved ejection fraction (diastolic dysfunction / HFPEF) Background • Most common cause: coronary artery disease • 30–40% of patients die within a year of diagnosis Prevalence • Around 900,000 people in the UK • Expected to rise in the future Background It accounts for 5% of hospital admissions and readmissions 1 million in patient bed days Nationally 2% of all NHS inpatient days Nationally 5% of all emergency admissions Heart failure in Croydon 0.5% reported prevalence (2008/9) – 1,832 HF patients identified Expected prevalence 1.1% - (2007/8 – 2008/9) Potential of 0.6% - 2,378 HF patients not diagnosed NICE HF Quality Standards GP survey/ CQUIN Current Referral Criteria to the Integrated HF Specialist Nurse Service Confirmed diagnosis of heart failure on echocardiogram essential Left ventricular systolic dysfunction Preserved heart failure/diastolic dysfunction HF with valve dysfunction HF with atrial fibrillation Integrated HF Team Nurse-led clinics ‘HOT’ Clinic Telehealth* HF Care and supporting services closer to home. Domiciliary visit HF MDT Meetings Role of the HF nurse • Support and develop the clinical management plan • Identification of HF patients at CUH. • Ensuring correct EVB medication and up titration, monitoring of symptoms , biochemistry and observations . • Ensuring appropriate investigations for HF • Referral on to a cardiology consultant if appropriate • Case management of complex patients Role of the HF nurse • Reviewing those nearing end of life, liaison with palliative care • Working with local and national HF guidelines • Improved quality of life for patients • Patient empowered through education towards self management of condition • Aim to reduce emergency admissions and length of stay • Aim to reduce readmission after an acute exacerbation HFSN Clinics • CUH (2 x weekly) • Norbury health centre -Wednesday mornings • Sanderstead Clinic - Thursday • Future clinics • New Addington • Woodside ( previous clinic) Domiciliary visits for those who cannot travel. Referrals sources GPs CUH - Cardiology , medicine , Care of the elderly etc. Tertiary centres - SGH, KGH and GSTT Referrals from MDT ( Community matrons, Health visitors for older people , District nurses, Stroke team , palliative care ) Telehealth in heart failure • New innovation for CHS • Effective in HF management • Increases self management of condition e.g. prompts daily weights, recognition of fluid retention. • Medication concordance. • Reassures anxious patients Aim to reduce unplanned admissions and exacerbations Referral Process ha recent Echo ( past 2 yrs. ) CHS website Working towards single point for HFSN referrals - nurse led triage and appropriate place for review. Developing HF Chronic Care Assessment Discharging from service Once patient is stable and optimised on maximum tolerated EVB anti-failure medication Easy access for referral back , for both GPs and patients Recent GP questionnaire Recommended 6 monthly follow up at surgery, as per NICE HF quality standards HF nurses available as a resource for GPs and the MDT Thank you Any questions ?
