A Program Evaluation of a Nurse-led Interdisciplinary Heart Failure Clinic

Abstract

Heart failure (HF) is a major health disparity that accounts for a vast number of hospitalizations as well as re-hospitalizations. In 2006. the estimated direct cost of HF in the United States (US) was 29.6 billion dollars (American Heart Association [AHA], 2005). HF is not only costly but it also accounts for approximately 287,000 deaths in the US each year (AHA). Significant improvements in patient outcomes are evident when patients are referred to HF clinics. From the literature it appears that referred clients have less frequent re-hospitalizations in addition to improved quality of life. Nurse-led outpatient HF clinics offer behavioral specific knowledge necessary to engage in health promotion. Due to the complexity of the disease, it is appropriate to refer clients diagnosed with HF to nurse-led outpatient HF clinics. The purpose of this project was to validate and possibly expand knowledge about specific aspects of the nursing role in particular that contribute to improved outcomes in nurse-led HF clinics. A nurse interview and nurse-client observations were performed with specific emphasis on the role of the nurse. Scores were assessed on five clients using the Minnesota Living with Heart Failure questionnaire. Each demonstrated improvement on questionnaire responses during the six month period, with scores varying in improvement from I 0-12 points at the six month mark. Statistics related to re-hospitalization rates and ER visits were provided for the program evaluation by the clinic. The HF clinic demonstrated a 30 day re-hospitalization rate less than the national average of 24o/o, with a percentage of 18.6o/o. Components of a successful program were observed during an evaluation of the program. Recommendations and implications for advanced practice are discussed.