Are we are all heart failure nurses?

Abstract

Heart failure (HF) nursing is commonly regarded as a small subspecialty of our profession. I often poll groups of nurses I have the pleasure of meeting as to their self-identification as HF nurses. I typically get a very small positive response. It is my hope that as we reach out to our colleagues by promoting a broader understanding as to what constitutes HF, we may expand our HF nursing community and place greater emphasis on the prevention of symptomatic HF. HF nursing is generally misunderstood as caring primarily for symptomatic, chronically, terminally ill patients. Until there is a paradigm shift emphasizing prevention, we will likely make little headway with regard to HF morbidity and mortality. Despite the impressive advances in the treatment of this devastating disease over the last decades, HF continues to be the number one hospital discharge diagnosis, making it the “biggest loser” for hospitals in the United States.1CMS Medicare Provider Analysis and Review (MEDPAR) National 2001 Inpatient Discharge Database MEDPAR, DRG 127.Google Scholar In addition, patients with HF still have a staggering 50% mortality 5 years after diagnosis.2Aghababian R.V. Acutely decompensated heart failure: opportunities to improve care and outcomes in the emergency department.Rev Cardiovasc Med. 2002; 3: S3PubMed Google Scholar The American Heart Association and the American College of Cardiology took bold steps in promoting the prevention of symptomatic HF by defining the stages of HF.3Hunt S.A. American College of CardiologyAmerican Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).J Am Coll Cardiol. 2005; 46: e1-e82Abstract Full Text PDF PubMed Scopus (1275) Google Scholar Defining asymptomatic patients with cardiovascular risk factors, including type II diabetes mellitus and hypertension as stage A HF, should be a wake-up call for healthcare providers and patients. If we can aggressively manage cardiovascular risk factors, we can prevent the progression to symptomatic HF. This is the subset of patients with HF we presently care for in HF clinics and cardiology practices. The majority of patients with HF (stages A and B) are followed in the primary care setting. In view of the limited clinic time most primary care practitioners have with patients, this presents a challenge. It is incumbent on nurses to recognize their patients with cardiovascular disease or risk factors as already being patients with HF. An immediate treatment goal may be to prevent that second myocardial infarction or stenosed coronary artery, but ultimately the goal should be to prevent stages C and D HF. Our personal mission should be to prevent the progression of HF. This will involve patient education and participation. The idea of personal responsibility for one's health has garnered much recent debate in national health care discussions. Aggressive treatment of stages A and B HF will require expert medical and nursing care, but also patient engagement in implementing the behavioral changes necessary to control modifiable risk factors. This is what nurses do best. We educate and advocate for patients. We are partners in HF healthcare. So, back to the original title question: Are we all HF nurses? Perhaps not “all,” but I think we can agree on “most.” If we care for patients with hypertension, diabetes mellitus, coronary artery disease, valvular heart disease, or prior myocardial infarctions, we are, in fact, HF nurses. Perhaps recognizing ourselves as such will be a first step to aggressive prevention of symptomatic HF. Vera Barton-Caro, RN, MSN, FNP-BC Vera is a nurse practitioner/nurse manager for Richard F. Terry, MD, an outpatient cardiology practice and heart failure clinic in Wheeling, West Virginia. She is pursuing her PhD in nursing from West Virginia University, is a reviewer for Heart & Lung and The Journal of Cardiac Failure, and is an active member of the Heart Failure Society of America and the American Heart Association