Nurse-led Heart Failure Clinic Research Articles

The management of heart failure in Sweden-the physician's perspective: a survey.

To assess the barriers to guideline-directed medical therapy (GDMT) use in heart failure (HF), diagnostic workup and general knowledge about HF among physicians in Sweden. A survey about the management of HF was sent to 828 Swedish physicians including general practitioners (GPs) and specialists during 2021-2022. Answers were reported as percentages and comparisons were made by specialty (GPs vs. specialists). One hundred sixty-eight physicians participated in the survey (40% females, median age 43 years; 41% GPs and 59% specialists). Electrocardiography and New York Heart Association class evaluations are mostly performed once a year by GPs (46%) and at every outpatient visit by specialists (40%). Echocardiography is mostly requested if there is clinical deterioration (60%). One-third of participants screen for iron deficiency only if there is anemia. Major obstacles to implementation of different drug classes in HF with reduced ejection fraction are related to side effects, with no significant differences between specialties. Device implantation is deemed appropriate regardless of aetiology (69%) and patient age (86%). Specialists answered correctly to knowledge questions more often than GPs. Eighty-six percent of participants think that GDMT should be implemented as much as possible. Most participants (57%) believe that regular patient assessment in nurse-led HF clinics improve adherence to GDMT. Obstacles to GDMT implementation according to physicians in Sweden mainly relate to potential side effects, lack of specialist knowledge and organizational aspects. Further efforts should be placed in educational activities and structuring of nurse-led clinics.

Examining the real-world up-titration of heart failure therapy and treatment related factors limiting optimisation in Irish nurse-led heart failure clinics

Abstract Introduction The potential of guideline-directed heart failure therapy to reduce mortality and morbidity in HF patients is tremendous however real-world data indicates sub-optimal up-titration to target doses. Challenges to optimisation include patient-related factors, treatment related factors and service-related factors. The observational QUALIFY Study reported a prescription rate of 87.8% for ACEI's/ARB's, 86.9% for Beta-blockers and 70.3% for MRA's. Purpose To examine the real-world pattern of up-titration and maximisation of four pillars of HF therapy to maximum doses in Irish Nurse-led HF Clinics in comparison to recent observational/registry studies and to highlight the main treatment related factors limiting optimisation. Methods A cross sectional prospective audit over a 3-month period was carried out in 18 HF centres in Ireland. Ethical approval was sought and granted in all centres. Patients included in the audit were those with HFrEF that achieved optimal tolerated dose of betablocker, ARNI/ACE-I, MRA and SGLT2I during the period of the audit. Results The audit included 648 participants, 499 (77%) male and 147 (23%) female (2 unknown). Average age of male was 68.5 years old and female was 68.7 years old. The rate of prescription for ARNI and ACEi/ARB was 93.8% (n=608), 65% (n=420) of patients were prescribed ARNI, ACEi were prescribed for 147 (22.6%) and ARB’s for 41 (6.3%) patients respectively. Hypotension was a limiting factor in 22.4% (n=146) of cases. Over 608 (93.6%) patients received a beta-blocker to maximum tolerated dose and 6% (n=40) did not receive a beta-blocker. Hypotension was a limiting factor for 77 (11.8%) patients, followed by fatigue in 15 (2.3%) of patients. 84% of patients received an MRA and 97 (14.9%) patients did not received an MRA. Hyperkalaemia was a limiting factor in 51 cases (7.8%), followed by chronic kidney disease in 32 cases (4.9%) and hyponatraemia in 6 cases (0.9%). Only 13.2% (n=86) of patients did not receive an SGLT2 and 86.8% were prescribed an SGLT2. Urinary tract infection was reported in 13 cases (2%), CKD preluded prescription in 7 patients (1%) and fungal infection occurred in 3 cases (0.4%). Conclusion A strong commitment to optimising heart failure therapy is evident in Irish nurse-led clinics. Prescription rates for patients optimised were 93.8% for ARNI/ACE/ARB, 93.6% for BB, 84% for MRA and 86.8% for SGLT2. This has surpassed target doses seen in observation studies. Future audits will examine the impact of nurse prescribing on the achievement of optimal target doses.

Feasibility and acceptability of using a patient reported outcome measure (OxFAB) to help patients with heart failure to recognise and communicate worsening symptoms to specialist nurses

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Nursing Council for England and Wales Trust Background The incidence of Heart Failure (HF) is increasing. Breathlessness and fatigue are symptoms that signal clinical deterioration. However, patients often do not recognise worsening symptoms. This can lead to avoidable hospital admission. We developed with patients a validated tool to evaluate fatigue and breathlessness (OxFAB) in patients with HF but had not established its acceptability and feasibility in clinical practice. Purpose To evaluate the feasibility and acceptability of OxFAB as a tool to optimise patient-specialist nurse communication of symptoms of fatigue and breathlessness. Methods A multi-method feasibility study conducted in HF nurse specialist clinics at two sites in England, between January 2022 and September 2022. Participants completed the tool in the clinics at 2 time points 4 to 7 weeks apart. The tool asked for symptom assessment over the previous 2 weeks. Acceptability was determined through qualitative interviews and adherence to OxFAB at the 2 time points. Feasibility was determined through questionnaire completion rates and qualitative interviews. Results Thirty-five patients and three HF nurse specialists completed the study. Nurse-led HF clinics were conducted either by telephone consultation remotely or face to face within the hospital setting. Over half the patient sample were male (58%), and 66% of the patients had HF with reduced ejection fraction, 86% NYHA Class II-III, age (µ68.5 years-SD 12.55) years. Eighty-one percent completed OxFAB in µ7.49 minutes (time-point 1) and µ6.59-mins (time-point 2). Interview data suggested that OxFAB was easy to complete, relevant and optimised symptom communication. Conclusion This feasibility study demonstrated OxFAB was acceptable and feasible in clinical practice to optimise patients-health professional communication of HF symptoms.

Effects of exergaming and yoga on exercise capacity, symptoms, functional capacity, and physical and mental health in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish National Science Council and The Swedish Heart-Lung Foundation Background Many people with chronic heart failure have a sedentary lifestyle. Alternative forms of physical activity might be beneficial, and should be considered, especially for patients with heart failure who are less inclined to start programs using traditional modes of exercise. Exergaming and yoga are promising interventions for improving functional capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure. Objective To explore effects of exergaming at home and medical yoga in a group on functional capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure. Methods This is a sub-study within a larger randomized controlled trial (the HF-Wii trial) with a three-months intervention and outcomes measures at baseline, three, six, and twelve months. Study particpants were recruited from nurse-led heart failure clinics at two university hospitals in Sweden. Randomization was in a 1:1:1 ratio to either an exergame intervention, a medical yoga intervention, or an active control group. Exercise capacity was assesed using the six-minute walk test. Symptoms (shortness of breath and fatigue) were assessed with a numeric rating scale ranging from 0-10. Well-being was assessed with Cantril’s ladder of life. Health-related quality of life was examined by the Minnesota Living with Heart failure Questionnaire. Anxiety and depression were measured with the hospital anxiety and depression scale. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time. Results In total, 104 patients (37% women, mean age 71±12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n=35), medical yoga (n=33), or an active control group (n=36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life (all p< 0.05) and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at three months (p = 0.047). Conclusions This randomized sub-study showed that both exergaming and medical yoga had favorable effects on outcomes, with exergaming, with its higher physical intensity, having effects on physical health and with medical yoga being a mind-body intervention with effects on emotional well-being.

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

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.

Impact of a Nurse-Led Multidisciplinary Heart Failure Clinic in a Low-Resource Setting: Experience in a Latin American Public Healthcare System

BackgroundNurse-led multidisciplinary heart failure clinics (MDHFCs) play an important role in patient care in developed countries, due to their proven benefits relating to mortality, hospitalization, and quality of life. However, evidence is limited regarding the role of MDHFCs in a limited-resource setting. MethodsPatients with heart failure (HF) with reduced ejection fraction (n = 89) were enrolled in a prospective, longitudinal cohort, from January 2018 to January 2019. The following endpoints were collected at baseline and after 6 months of follow-up: (i) quality of life, measured using the Minnesota Living with Heart Failure Questionnaire; (ii) medication adherence using the Morisky Medication Adherence Scale, 8-item; (iii) titration of HF medications; (iv) self-care behavior using the European Heart Failure Self-care Behavior Scale; and (v) mortality and hospitalizations up to 12 months after. ResultsThe questionnaire score was reduced from 66.5 (interquartile range [IQR], 46-86) at baseline to 26 (IQR, 13-45) at 6 months (P < 0.001). New York Heart Association (NYHA) functional class improved at 6 months (NYHA I: 41.9%; NYHA II: 39.5%; NYHA III: 17.2%), compared to baseline (NYHA I: 20%; NYHA II: 49%; NYHA III: 31%; P < 0.001). Medication adherence using the 8-item Morisky Medication Adherence Scale improved the score from 6 (IQR, 4-7) at baseline to 7 (IQR, 6.25-8; P = 0.001) at 6 months. Uptitration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (25% vs 18% at target dose) and beta-blockers (25% vs 11% at target dose) was documented. After 6 months of follow-up, the European Heart Failure Self-care Behavior Scale was applied, showing a score of 18.5 (IQR, 15-22). The mortality reported at 12 months of follow-up was 9.7%, and the incidence of hospitalization was 44%. ConclusionAn MDHFC is a feasible strategy to manage an HF clinic in a low-resource setting.

Right ventricular dysfunction in patients with new-onset heart failure: longitudinal follow-up during guideline-directed medical therapy.

Improvement in left ventricular ejection fraction (LVEF) after up-titration of guideline-directed medical therapy (GDMT) has been well described in heart failure (HF) patients. Less is known about the prevalence and clinical course of right ventricular dysfunction (RVD) in patients with new-onset HF. From 2012 to 2018, 625 patients with a recent (<3 months) diagnosis of HF were referred to a specialized nurse-led HF clinic for protocolized up-titration of GDMT. RVD, defined as tricuspid annular plane systolic excursion (TAPSE) <17 mm, was assessed at baseline and at the follow-up visit. Patients were followed for the combined endpoint of all-cause mortality and HF hospitalization for a mean of 3.3 ± 1.9 years. Of the 625 patients, 241 (38.6%) patients had RVD at baseline. Patients with RVD were older, more symptomatic, had a lower LVEF, and more often had a history of cardiothoracic surgery and atrial fibrillation. After a median follow-up of 9 months, right ventricular function normalized in 49% of the patients with baseline RVD. RVD at baseline was associated with a higher risk of the combined endpoint (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.21-2.18). Right ventricular function normalization was associated with a lower risk for the combined endpoint (HR 0.56, 95% CI 0.31-0.99), independent of baseline TAPSE, age, sex, and LVEF. More than one-third of patients with new-onset HF have RVD. RVD is associated with a higher risk of all-cause mortality and HF hospitalization. Recovery of RVD regularly occurs during up-titration of GDMT and is associated with improved clinical outcomes.

Validation of the ELAN-HF Score and self-care behaviour on the nurse-led heart failure clinic after admission for heart failure

AimTo validate the predictive value of the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, and to assess the effect of self-care behaviour on readmission and mortality in patients after admission with acute decompensated heart failure (ADHF).DesignQuantitative, prospective, single centre, cohort study.MethodsN-Terminal pro–B-type natriuretic peptide (NT-proBNP) levels were measured on admission and discharge, and were used together with clinical and laboratory parameters to calculate the ELAN-HF score. Patients were stratified into four risk groups (low, intermediate, high, very high) according to their ELAN-HF score. The performance of the ELAN-HF score was evaluated and compared to the original study. Self-care behaviour was assessed by the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Survival analysis was used to estimate the association between both scores and re-admission for HF and/or all-cause mortality within 180 days.Results88 patients were included. The median age of the study population was 75 years (IQR 69–83), 43% was female. NYHA III/IV functional class was present at discharge in 68 patients (85%) and 27 patients (34%) had a left ventricular ejection fraction < 40%. Complete data and 180 day follow up was available for 80 patients. 55% reached the endpoint of readmission and/or all-cause mortality. There was a significant association between the ELAN-HF score and re-admission and/or mortality < 180 days (HR = 1.25, 95% CI 1.08—1.45, p = 0.003). The median EHFScBS-9 score was 68.1 (IQR 58.3 – 77.8). There was no significant association between the EHFScBS-9 score and readmission and/or mortality < 180 days (HR = 1.01, 95% CI 0.99—1.03, p = 0.174).ConclusionThis study confirms the validity and therefore the potential of the ELAN-HF score to triage patients with ADHF before discharge. Using this score may optimize the follow-up treatment on the nurse-led heart failure clinic in order to decrease readmission and mortality. Self-care behaviour was non-significantly associated with readmission and/or mortality in our study population.Trial RegistrationThis study has been registered with the ethics committee MEC-U (Nieuwegein, The Netherlands), registration nr: V.160999/W18.208/HG/mk.

Patient profile and outcomes associated with follow-up in specialty vs. primary care in heart failure.

AimsFactors influencing follow‐up referral decisions and their prognostic implications are poorly investigated in patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF). We assessed (i) the proportion of, (ii) independent predictors of, and (iii) outcomes associated with follow‐up in specialty vs. primary care across the EF spectrum.Methods and resultsWe analysed 75 518 patients from the large and nationwide Swedish HF registry between 2000–2018. Multivariable logistic regression models were fitted to identify the independent predictors of planned follow‐up in specialty vs. primary care, and multivariable Cox models to assess the association between follow‐up type and outcomes. In this nationwide registry, 48 115 (64%) patients were planned for follow‐up in specialty and 27 403 (36%) in primary care. The median age was 76 [interquartile range (IQR) 67–83] years and 27 546 (36.5%) patients were female. Key independent predictors of planned follow‐up in specialty care included optimized HF care, that is follow‐up in a nurse‐led HF clinic [odds ratio (OR) 4.60, 95% confidence interval (95% CI) 4.41–4.79], use of HF devices (OR 3.99, 95% CI 3.62–4.40), beta‐blockers (OR 1.39, 95% CI 1.32–1.47), renin–angiotensin system/angiotensin‐receptor‐neprilysin inhibitors (OR 1.21, 95% CI 1.15–1.27), and mineralocorticoid receptor antagonists (OR 1.31, 95% CI 1.26–1.37); and more severe HF, that is higher NT‐proBNP (OR 1.13, 95% CI 1.06–1.20) and NYHA class (OR 1.13, 95% CI 1.08–1.19). Factors associated with lower likelihood of follow‐up in specialty care included older age (OR 0.29, 95% CI 0.28–0.30), female sex (OR 0.89, 95% CI 0.86–0.93), lower income (OR 0.79, 95% CI 0.76–0.82) and educational level (OR 0.77, 95% CI 0.73–0.81), higher EF [HFmrEF (OR 0.65, 95% CI 0.62–0.68) and HFpEF (OR 0.56, 95% CI 0.53–0.58) vs. HFrEF], and higher comorbidity burden, such as presence of kidney disease (OR 0.91, 95% CI 0.87–0.95), atrial fibrillation (OR 0.85, 95% CI 0.81–0.89), and diabetes mellitus (OR 0.92, 95% CI 0.88–0.96). A planned follow‐up in specialty care was independently associated with lower risk of all‐cause [hazard ratio (HR) 0.78, 95% CI 0.76–0.80] and cardiovascular death (HR 0.76, 95% CI 0.73–0.78) across the EF spectrum, but not of HF hospitalization (HR 1.06, 95% CI 1.03–1.10).ConclusionsIn a large nationwide HF population, referral to specialty care was linked with male sex, younger age, lower EF, lower comorbidity burden, better socioeconomic environment and optimized HF care, and associated with better survival across the EF spectrum. Our findings highlight the need for greater and more equal access to HF specialty care and improved quality of primary care.

Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction.

ObjectiveRecent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and a reduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in left ventricular ejection fraction (LVEF), and mortality.MethodsFrom 2012 to 2018, 378 HFrEF patients with a recent (< 3 months) diagnosis of HF were referred to a specialised HF-nurse led clinic for protocolised up-titration of guideline-directed medical therapy (GDMT). The achieved doses of GDMT at 9 months were recorded, as well as reasons for not achieving the optimal dose in all patients. Echocardiography was performed at baseline and after up-titration in 278 patients.ResultsOf 345 HFrEF patients with a follow-up visit after 9 months, 69% reached ≥ 50% of the recommended dose of renin-angiotensin-system (RAS) inhibitors, 73% reached ≥ 50% of the recommended dose of beta-blockers and 77% reached ≥ 50% of the recommended dose of mineralocorticoid receptor antagonists. The main reasons for not reaching the target dose were hypotension (RAS inhibitors and beta-blockers), bradycardia (beta-blockers) and renal dysfunction (RAS inhibitors). During a median follow-up of 9 months, mean LVEF increased from 27.6% at baseline to 38.8% at follow-up. Each 5% increase in LVEF was associated with an adjusted hazard ratio of 0.84 (0.75–0.94, p = 0.002) for mortality and 0.85 (0.78–0.94, p = 0.001) for the combined endpoint of mortality and/or HF hospitalisation after a mean follow-up of 3.3 years.ConclusionsThis study shows that protocolised up-titration in a nurse-led HF clinic leads to high doses of GDMT and improvement of LVEF in patients with new-onset HFrEF.Supplementary InformationThe online version of this article (10.1007/s12471-021-01591-6) contains supplementary material, which is available to authorized users.

Baseline Characteristics, Management and Outcomes of Patients With Heart Failure and Preserved Ejection Fraction in a Nurse Facilitated Care Model

Introduction: Current clinical guidelines recommend that patients with heart failure (HF) receive multidisciplinary care at nurse-led HF clinics both for optimisation of medical therapies and to reduce preventable readmissions. Methods: We present the biological and clinical characteristics of patients with HF and preserved ejection fraction (HFPEF) and the clinical outcomes achieved (all-cause mortality [ACM] or HF hospitalisation) within the GenesisCare Heart Failure Management Clinics (GC-HFMC). GC-HFMCs are a HF specialist led, nurse-facilitated model providing comprehensive pharmacological and non-pharmacological management, HF education and a HF nurse support service. Results: The cohort (n = 297) was predominantly female (62%) with mean age 79 ± 10 years, median LVEF of 60% (IQR 55,65) and NYHA class II (56%) and III (34%). Community referrals accounted for 80% of patients, with 20% referred post hospitalisation. There was a high incidence of comorbidities, such as hypertension (83%), dyslipidaemia (65%), arrhythmia (64%), diabetes (34%), chronic renal failure (45%), airway disease (33%) and anaemia (31%). The STOP-Bang score indicated 76% of patients were high risk for obstructive sleep apnoea (OSA) but only 15% had a known OSA diagnosis. Medications included BB (57%), ACEI/ARB (59%) and diuretics (81%). Patient satisfaction with care was high (net promoter score >80%). At one year, the combined end point of ACM or HF hospitalisation occurred in 11.1%, and ACM occurred in 6.4%. Conclusions: The findings demonstrate the impact of nurse facilitated GC-HFMCs in providing quality care and delivering low hospitalisation and mortality rates.

Introducing nurse-led heart failure clinics in Swedish primary care settings.

According to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients' experiences of HF clinics in PC. The study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (P < 0.001), HF hospital days by 27.3% (P < 0.001) and HF emergency room visits by 24% (P < 0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic. Nurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care.

PREDICTORS OF AND OUTCOMES ASSOCIATED WITH REFERRAL TO A HEART FAILURE NURSE-LED CLINIC: AN ANALYSIS OF 40,992 PATIENTS FROM THE SWEDISH HEART FAILURE REGISTRY

Follow-up (FU) in a nurse-led HF clinic (NLc) may improve outcomes and reduce costs in heart failure (HF); thus, it is recommended as part of the HF management team in HF guidelines. Previous studies included highly selected patients (pts) and large analyses of “real-world” samples are missing.

Family Health Conversations Conducted by Telephone in Heart Failure Nursing Care: A Feasibility Study.

Registered nurses (RNs) in heart failure (HF) nursing care have a key role in providing family support, which positively affects the outcome for the patient. Telephone interventions conducted by RNs have been reported to be successful in HF nursing care, but Family Health Conversations (FamHCs) involving the patient and the family, have not previously been tested. The purpose of the current study was to explore the experiences and feasibility of nurse-led FamHCs conducted by telephone with patients and their family caregivers. A single-group intervention study with a pretest–posttest design was conducted in three regional hospitals that had a nurse-led HF clinic. Five RNs, eight patients, and eight family caregivers participated. Three FamHCs were conducted by telephone with each family every 2 weeks. Qualitative and quantitative data were collected through semistructured interviews and questionnaires. FamHCs improved the nurse–family relationships and relationships within the families and provided RNs with new knowledge about the families. FamHCs conducted by telephone were considered to be feasible for both families and RNs, although RNs preferred fewer and shorter FamHCs. The RNs preferred meeting face-to-face with the families as nonverbal communication between the family members could be missed because of lack of visual input. On the other hand, RNs appreciated to focus entirely on the conversation without the need to perform illness-related routine checks. In conclusion, the advantages of FamHCs conducted by telephone outweighed the disadvantages. Visual contact, provided by video telephony, and a shorter version of the tested FamHC would facilitate the use in HF nursing care.

A Nurse Led Clinic’s contribution to Patient Education and Promoting Self-care in Heart Failure Patients: A Systematic Review

Introduction: Heart failure (HF) is a medical condition whereby the heart’s efficency is compromised. Typical symptoms include breathlessness, tiredness and ankle swelling and signs of increased heart rate, lung congestion or raised jugular venous pressure. It is confirmed by the presence of a structural or functional abnormality of the heart on echocardiograph. HF significantly affects the patient’s quality of life (QoL). HF is a major problem for society affecting 1-2% of adults in developed countries (Mosterd and Hoes 2007), in excess of 90,000 people in Ireland are affected (Corry et al. 2015). Background: The incidence and prevalence as well as high hospital admission rates, increase the cost of and burden of HF. Chronic disease management programmes developed nurse-led clinics and collaboration of the multi-disciplinary team (MDT) to improve HF guideline implementation and outcomes. Educating patients on the self-care skills and knowledge necessary to control symptoms and avoid hospitalisation, which include daily weight, symptom monitoring and seeking timely medical care for deterioration is vital. Self-care is the decisions and choice of behaviours by the individual in order to maintain life, healthy functioning and well-being (Reigel and Carlson 2002, Jaarsma et al. 2003). Cowie et al (2014) examined Acute HF in Europe and the USA recommending: Optimising care accross institutions, improving patient education/ support, providing equitable care, enhancing end of life care, and increasing HF prevention. Aim: To examine the evidence for the role of the nurse-led clinic in patient education on the outcomes of Self-Care and QoL for HF patients. Methodology: A search of the databases CINHAL, PubMed, Science Direct and Medline was conducted. Search criteria: Adult HF patients aged over 18years, attending Nurse-led HF clinics/ nurse managed HF care programmes, English language only, No geographical limit, Published 2006-2016. Inclusion Criteria: Original Research, Interventions delivered through nurse led clinics, patient education, self-care skills, health assessment, and referral to MDT. Grey literature- online reports x 2 and small unpublished local population study. Results: Sixty eight studies were identified spanning 12 countries, various components of disease management programmes such as goal setting & motivational interviewing, educational and self-care needs, barriers and facilitators. Characteristics included all classes of HF, group or individualised programmes. Themes identified included: learning needs; knowledge, symptom recognition, barriers to learning, self-care skills, role of social/ caregiver support and a therapeutic nurse/patient/relationship. Conclusion: The patient’s need to be connected is highlighted by the review. Quantitative measures of self-care tools and patient satisfaction are augmented by patient reported outcomes and rich qualitative data. Cognitive impairment and depression may interfere with learning, decision-making and perception of symptoms.. The evidence supports the need for individualised patient educational plans and management strategies. Lifestyle changes may include controlling or modifiying risk factors (Dickstein et al. 2008). Adherence to guidelines and supporting patient autonomy are also important. Patients must learn and understand the relevant self-care behaviour required (Stromberg 2005, McMurray et al. 2012), gain the necessary skills to act on deteriorating symptoms and ways of increasing activity adjusted to functional capacity and energy conservation. Through education adapted to patient’s needs and goals, Self-Care is promoted and quality of life is improved. Further research is needed into other factors that affect QoL screening and the use of nursing taxonomies.

Quality of life improves in patients with chronic heart failure and Cheyne-Stokes respiration treated with adaptive servo-ventilation in a nurse-led heart failure clinic.

The aim of this study was to investigate if quality of life improved in chronic heart failure patients with Cheyne-Stokes respiration treated with adaptive servo-ventilation in nurse-led heart failure clinic. Cheyne-Stokes respiration is associated with decreased quality of life in patients with chronic heart failure. Adaptive servo-ventilation is introduced to treat this sleep-disordered breathing. Randomised, controlled design. Fifty-one patients (ranging from 53-84years), New York Heart Association III-IV and/or left ventricular ejection fraction ≤40% and Cheyne-Stokes respiration were randomised to an intervention group who received adaptive servo-ventilation or a control group. Minnesota Living with Heart Failure Questionnaire was used to assess quality of life at randomisation and after three months. Both groups were followed in the nurse-led heart failure clinic. Adaptive servo ventilation improved quality of life-scores both in a per protocol analysis and in an intention to treat analysis. Twenty-one patients dropped out of the study, nine in the control and 12 in the intervention group. Use of adaptive servo-ventilation improved quality of life in chronic heart failure patients with Cheyne-Stokes respiration. However, the drop-out rate was high. Chronic heart failure patients come regularly to the nurse-led heart failure clinic. The heart failure nurses' competency has to include knowledge of equipment to provide support and continuity of care to the patients.

Nurses’ attitudes toward family importance in heart failure care

Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure. To involve family members in heart failure care is thus valuable for the patients. Registered nurses frequently meet family members of patients with heart failure and the quality of these encounters is likely to be influenced by the attitudes registered nurses hold toward families. To explore registered nurses' attitudes toward the importance of families' involvement in heart failure nursing care and to identify factors that predict the most supportive attitudes. Cross-sectional, multicentre web-survey study. A sample of 303 registered nurses from 47 hospitals and 30 primary health care centres completed the instrument Families' Importance in Nursing Care - Nurses' Attitudes. Overall, registered nurses were supportive of families' involvement. Nonetheless, attitudes toward inviting families to actively take part in heart failure nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a primary health care centre, a heart failure clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and/or heart failure nursing care, and a competence to work with families. Experienced registered nurses in heart failure nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. Registered nurses who have designated consultation time with patients and families, as in a nurse-led heart failure clinic, may have the most favourable condition for implementing a more supportive approach to families.

Registered Nurses' Perceptions about the Situation of Family Caregivers to Patients with Heart Failure - A Focus Group Interview Study.

IntroductionHeart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes.AimsThe aims of this study are to explore registered nurses’ perceptions about the situation of family caregivers to patients with heart failure, and registered nurses’ interventions, in order to improve family caregivers’ situation.MethodsThe study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis.ResultsTwo content areas were identified by the a priori study aims. Four categories and nine sub-categories emerged in the analysis process. The content area “Family caregivers' situation” includes two categories: “To be unburdened” and “To comprehend the heart failure condition and its consequences”. The content area “Interventions to improve family caregivers' situation” includes two categories: “Individualized support and information” and “Bridging contact”.ConclusionsRegistered nurses perceive family caregivers' situation as burdensome, characterized by worry and uncertainty. In the PHCCs, the continuity and security of an RN as a permanent health care contact was considered an important and sustainable intervention to better care for family caregivers' worry and uncertainty. In the nurse-led heart failure clinics in hospitals, registered nurses can provide family caregivers with the opportunity of involvement in their relative's health care and address congruence and relationship quality within the family through the use of "Shared care" and or Family-centred care. Registered nurses consider it necessary to have a coordinated individual care plan as a basis for collaboration between the county council and the municipality.

Effects of a nurse-led heart failure clinic on hospital readmission and mortality in Hong Kong.

BackgroundHeart failure (HF) is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong.MethodsThis study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged ≥ 65 years old and stayed in the clinic over a six-month period.ResultsThe data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male (51.3%), almost half were smokers (46.2%), and the majority received ≤ six years of formal education. Most of the HF patients (87.2%) belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15 ± 20.31 mL. The HF patients who attended the clinic (n = 38, 75.13 ± 5.89 years) were significantly younger than those who did not attend the clinic (n = 40, 79.53 ± 6.96 years) (P = 0.04), and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio (OR): 7.40; P < 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality (n = 4) than those who did not attend (n = 14). However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A significant reduction in systolic blood pressure [F (2, 94) = 3.39, P = 0.04] and diastolic blood pressure [F (2, 94) = 8.48, P < 0.01] was observed among the HF patients who attended the clinic during the six-month period.ConclusionsThe finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.

Effectiveness of advanced practice nurse-led heart failure clinics on all-cause mortality: a systematic review of quantitative evidence protocol

REVIEW OBJECTIVES/QUESTION The objective of this systematic review is to synthesize the best available evidence regarding the effectiveness of interventions delivered in advance practice nurse-led clinics on mortality in adult (19 years of age and older) patients with heart failure. The review question is: in adult patients,19 years of age and older, diagnosed with heart failure, what is the effectiveness of the interventions provided in advanced practice nurse-led heart failure clinics on all-cause mortality rates compared to usual care? INCLUSION CRITERIA Types of participants The review will consider studies that include patients who are 19 years of age or older, diagnosed with heart failure, regardless of gender, ethnicity, other co-existing health conditions, level of education, income or health insurance. Participants must have been assessed using an established classification or categorization system by a primary care provider (i.e. Advanced practice nurses, physician or cardiologist) at the beginning of the research study to determine their severity of symptoms or physical activity limitations. The New York Heart Association Functional Classification and the American Heart Association Stages of Heart Failure are two of the most widely used instruments. Types of intervention(s) The review will consider studies that evaluated evidence-based interventions delivered in Advanced practice nurses-led Heart Failure clinics compared to usual care. Usual care refers to all non-Advanced practice nurses-led Heart Failure clinics, care approaches including care provided by primary care physicians, or cardiology clinics and physician-led Heart Failure clinics. Advanced practice nurses-led Heart Failure clinics are defined as TRUNCATED AT 250 WORDS