Nurse Practitioner Led Cardiac Gym Clinic for Heart Failure Patients; A New Initiative

Abstract

Objective: The onsite hospital cardiac gym provides patients of the Advanced Heart Failure Service with a safe environment to exercise. Benefits of exercise in heart failure (HF) have been well documented [[1]NHF&CSANZ Guidelines for the prevention, detection and management of chronic heart failure in Australia. 2011; Google Scholar]. The HF nurse practitioner (NP) initiated a NP gym clinic aiming to provide clinical support and prompt solutions to presenting problems combined with medication management. NPs have been proven to improve outcomes for HF patients [[2]Kaan A. Dunne J. Development of a Nurse Practitioner Role in Heart Failure Management: An Australian Experience.Prog Cardiovasc Nurs. 2001; 16: 33-34Crossref PubMed Scopus (3) Google Scholar]. Management of HF includes optimisation of angiotension receptor antagonists and betablockers [[1]NHF&CSANZ Guidelines for the prevention, detection and management of chronic heart failure in Australia. 2011; Google Scholar] Design: The NP is onsite at the cardiac gym 1 day per week. This retrospective study reviews data collected over 12 months. Method: NP reviewed 74 patients, 63 male for 322 episodes. Average age 52 years (SD 12.8) with varying aetiology of heart failure, ejection fraction 27.4% (SD 12.9). Results: NP initiated 62% of cases, 59% for routine follow up and 41% due to a symptom change. Of symptoms reported, 51% were shortness of breath + - fluid overload. Treatment included medication optimisation and blood work. Most cases were independently managed by the NP without consultation with medical staff. Improvement in EF on echocardiogram increased to 38.4% (SD 13.6). Patient satisfaction was positive on survey. Conclusion: The presence of an NP in the cardiac gym proved to be a valuable adjunct to exercise. Patients were uptitrated to maximal doses of HF medications where tolerated. Improvement in EF on echo was statistically significant.