Nurse-Led Heart Failure Clinics: A Snapshot of Counties Manukau in 2021

Abstract

Heart failure is a complex clinical syndrome associated with significant morbidity and mortality. Evidence-based heart failure therapies are essential for improving outcomes of heart failure patients and nurse-led clinics can facilitate timely initiation and up-titration of these therapies. First-time and follow-up attendances to the nurse-led heart failure clinics were recorded in a database between May and December 2021. Demographic and diagnosis information was recorded, as well as the medication titration that occurred, the limitations to up-titration, and the follow-up plan. A total of 257 first visits took place, with a cumulative total of 542 visits for these patients. Patients were seen an average of 2.1 times over this time frame; 28% of patients were NZ Māori and 34% Pacific Islander. The average age was 57.9 years. Most patients (60%) have severe left ventricular impairment. Evidence-based heart failure medications were started during 96 clinic visits, and the dose was increased in 312 clinic visits. There were 177 instances where medications were unable to be started or up-titrated, due to the COVID-19 lockdown, and the resultant telehealth mode of delivery was a particular limitation. Nurse-led heart failure clinics are essential for helping patients become established and up-titrated on evidence-based heart failure therapies in a timely manner. While the COVID-19 lockdown had a significant impact in escalating therapy for patients, the data show that significant numbers of new patients are being seen, with a large volume of up-titration activity occurring in the clinics.